Provider Demographics
NPI:1134878192
Name:LINDSTROM, ANDERS MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:ANDERS
Middle Name:MICHAEL
Last Name:LINDSTROM
Suffix:
Gender:
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 1:300 EAST HOSPITAL ROAD
Mailing Address - Street 2:
Mailing Address - City:FOR GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:706-787-1745
Practice Address - Street 1:5300 57TH ST N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35217-3328
Practice Address - Country:US
Practice Address - Phone:052-808-3225
Practice Address - Fax:706-787-1745
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.2235171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider