Provider Demographics
NPI:1265589832
Name:PACKARD, FRANK LAWRENCE JR (PA-C)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:LAWRENCE
Last Name:PACKARD
Suffix:JR
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:PO BOX 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703
Mailing Address - Country:US
Mailing Address - Phone:706-602-7800
Mailing Address - Fax:
Practice Address - Street 1:100 JOHN MADDOX DR NW STE 100
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-3000
Practice Address - Country:US
Practice Address - Phone:706-528-9060
Practice Address - Fax:706-290-2399
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002269363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R68924Medicare UPIN
GA88BBBBZMedicare ID - Type Unspecified