Provider Demographics
NPI:1013980184
Name:LAFONT, DEREK AARON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:AARON
Last Name:LAFONT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3696 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6520
Mailing Address - Country:US
Mailing Address - Phone:706-736-1830
Mailing Address - Fax:706-650-7553
Practice Address - Street 1:3696 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6520
Practice Address - Country:US
Practice Address - Phone:706-736-1830
Practice Address - Fax:706-650-7553
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004721363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA639124321CMedicaid
GA639124321AMedicaid
GA639124321BMedicaid
GA639124321AMedicaid
GAQ64631Medicare UPIN