LELA FAIRCLOTH ALLEN (NPI# 1104024777) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104024777 |
| Entity Type | Individual |
| Full Name | LELA FAIRCLOTH ALLEN |
| Credential | PA-C |
| Practice Address |
3018 N Patterson St Valdosta GA 31602-1711 |
| Mailing Address |
Po Box 70 Valdosta GA 31603-0070 |
| Practice Telephone | 2294337200 |
| Practice Fax Number | 2292494031 |
| Mailing Telephone | 2294337200 |
| Mailing Fax Number | 2292494031 |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2017-05-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 003754 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 622508818C | 05 |
| Street Address |
3018 N PATTERSON ST |
| City | VALDOSTA |
| State | GA |
| Zip Code | 31602-1711 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083835227 | Anita D. Sinnott | Nurse Practitioner | 3018 N Patterson St, Valdosta, GA 31602-1711 | 2007-05-02 |
| 1306473400 | Chad Wesley Eisenhart | Dietitian, Registered | 3018 N Patterson St, Valdosta, GA 31602-1711 | 2020-03-26 |
| 1720451982 | Windy Giddens | Nurse Practitioner | 3018 N Patterson St, Valdosta, GA 31602-1711 | 2015-11-09 |
| 1720408065 | Jaanki Purohit | Dietitian, Registered | 3018 N Patterson St, Valdosta, GA 31602-1711 | 2014-04-25 |
| 1851672992 | Jodi Kimbell Seabrook | Dietitian, Registered | 3018 N Patterson St, Valdosta, GA 31602-1711 | 2011-09-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477198117 | Amber Michele Baugh | Behavior Technician | 2236 Bemiss Road, Valdosta, GA 31602 | 2019-11-15 |
| 1528611365 | Nishaben T. Patel | Nurse Practitioner | 3120 North Oak Street Extension, Suite B, Valdosta, GA 31602 | 2019-07-22 |
| 1427615871 | Blair Elizabeth Tomlinson | Nurse Practitioner | 2124 Lakeshore Drive, Valdosta, GA 31602 | 2019-05-21 |
| 1346704152 | Mildred Itaska Borowski | Counselor | 3790 North Highway 41, Suite A, Valdosta, GA 31602 | 2019-01-25 |
| 1962991703 | Southern Healthcare Alliance, LLC | Physical Medicine & Rehabilitation | 101-f W. Northside Drive, Valdosta, GA 31602 | 2018-05-08 |
| 1336636646 | Kaitlyn Thrift | Behavioral Analyst | 2225 Bemiss Road Suite D, Valdosta, GA 31602 | 2018-04-23 |
| 1407379845 | Lindsey Marie Richardson | Dentist | 103 W. Cranford Ave, Valdosta, GA 31602 | 2017-07-18 |
| 1962922427 | Taylor Nicole Fiveash | Nurse Practitioner | 101 W Northisde Dr, Bldg G, Valdosta, GA 31602 | 2017-06-26 |
| 1720520646 | Southern Sleepers Anesthesia LLC | Nurse Anesthetist, Certified Registered | 4120-b N. Valdosta Road, Valdosta, GA 31602 | 2016-11-09 |
| 1134670557 | Cataract and Laser Surgery Center of South Georgia, P.C. | Clinic/Center | 4120-b N. Valdosta Rd., Valdosta, GA 31602 | 2016-10-20 |
| Find all providers in zip 31602 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689021651 | Kayla Marie Rose | Physician Assistant | 3207 Country Club Drive, Bldg. B, Valdosta, GA 31605-1029 | 2016-05-19 |
| 1073633509 | Lonas Edward Lewis II | Physician Assistant | 3251 Inner Perimeter Rd Ste B, Valdosta, GA 31602-1026 | 2007-03-29 |
| 1902981996 | Bradley Gene Ridge | Physician Assistant | 3294 North Oak St. Ext., Valdosta, GA 31605 | 2006-10-26 |
| 1093816662 | Shonta K Winbush | Physician Assistant | 704 Gil Harbin Ind Blvd, Valdosta, GA 31602 | 2006-09-26 |
| 1851329155 | Stephanie P Young | Physician Assistant | 117 West Northside Drive, Valdosta, GA 31602 | 2006-06-28 |
| 1093759011 | Matthew Allan Thomas | Physician Assistant | 2412 N Oak St, Valdosta, GA 31602-2567 | 2006-06-16 |
| 1457329641 | Landis Coffee Gordon | Physician Assistant | 3527 N Valdosta Road, Valdosta, GA 31602 | 2006-03-14 |
| 1679541098 | Shawn E Tywon | Physician Assistant | 420 Northside Dr, Valdosta, GA 31602 | 2006-03-10 |
| 1629538822 | Trevor Lawton Davis | Physician Assistant | 3301 N Oak Street Ext, Valdosta, GA 31605 | 2019-03-22 |
| 1033675467 | Ashly Mcdaniel | Physician Assistant | 3527 N Valdosta Rd, Valdosta, GA 31602-6418 | 2019-02-11 |
| Find all providers in VALDOSTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.