Provider Demographics
NPI:1295108546
Name:CLARK, LINDSEY SHEA (PA-C)
Entity type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:SHEA
Last Name:CLARK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2360 ARROW CIR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-5004
Mailing Address - Country:US
Mailing Address - Phone:770-595-5137
Mailing Address - Fax:
Practice Address - Street 1:5438 PEACHTREE BLVD
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2232
Practice Address - Country:US
Practice Address - Phone:470-816-0988
Practice Address - Fax:470-398-3171
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10454363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant