Provider Demographics
NPI:1942279294
Name:BOOKHARDT, LINDSEY D (PA)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:D
Last Name:BOOKHARDT
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:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31598-0664
Mailing Address - Country:US
Mailing Address - Phone:912-588-1020
Mailing Address - Fax:912-588-1002
Practice Address - Street 1:1007 S MACON ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0242
Practice Address - Country:US
Practice Address - Phone:912-588-1020
Practice Address - Fax:912-588-1002
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004294363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant