Provider Demographics
NPI:1821292137
Name:LUMPKIN, SAMMIE LEAN (CSA)
Entity Type:Individual
Prefix:MISS
First Name:SAMMIE
Middle Name:LEAN
Last Name:LUMPKIN
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 POINTE CT
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213
Mailing Address - Country:US
Mailing Address - Phone:770-774-0406
Mailing Address - Fax:
Practice Address - Street 1:3621 POINTE CT
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-6001
Practice Address - Country:US
Practice Address - Phone:770-774-0406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3028OtherCSA