Provider Demographics
NPI:1245262153
Name:OWEN, LINDSAY N M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:N M
Last Name:OWEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LINDSAY
Other - Middle Name:NICOLE
Other - Last Name:MOORING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4720 NELSON BROGDON BLVD
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3480
Mailing Address - Country:US
Mailing Address - Phone:770-945-1990
Mailing Address - Fax:678-745-4193
Practice Address - Street 1:4720 NELSON BROGDON BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-3480
Practice Address - Country:US
Practice Address - Phone:770-945-1990
Practice Address - Fax:678-745-4193
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004788363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA192477383AMedicaid
97WCHTPMedicare PIN
Q70542Medicare UPIN