Provider Demographics
NPI:1144279399
Name:LAFAYETTE MEDICAL PROVIDERS
Entity type:Organization
Organization Name:LAFAYETTE MEDICAL PROVIDERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BALLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-638-1506
Mailing Address - Street 1:1201B N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-2150
Mailing Address - Country:US
Mailing Address - Phone:706-638-1506
Mailing Address - Fax:706-638-1507
Practice Address - Street 1:1201B N MAIN ST
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-2150
Practice Address - Country:US
Practice Address - Phone:706-638-1506
Practice Address - Fax:706-638-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care