Provider Demographics
NPI:1922403401
Name:MOFFITT, DUNCAN LESLIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:DUNCAN
Middle Name:LESLIE
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MEDICAL DRIVE
Mailing Address - Street 2:SUITE 701
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240
Mailing Address - Country:US
Mailing Address - Phone:706-882-8971
Mailing Address - Fax:706-882-8991
Practice Address - Street 1:300 MEDICAL DRIVE
Practice Address - Street 2:SUITE 701
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240
Practice Address - Country:US
Practice Address - Phone:706-882-8971
Practice Address - Fax:706-882-8991
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007416363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical