KEVIN LACK P.A.-C NPI 1417924028

NPI Information

NPI: 1417924028
Provider Name: KEVIN LACK, P.A.-C
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

PECOS Registration: Yes

Address:
3675 J DEWEY GRAY CIRCLE
SUITE 300
AUGUSTA, GA
ZIP 30909
Phone: (706) 863-9595
Get Directions

Kevin Lack, P.A.-C is a surgical physician assistant in Augusta, GA with 20 years of experience. Kevin Lack, P.A.-C NPI is 1417924028. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3675 J DEWEY GRAY CIRCLE
SUITE 300
AUGUSTA, GA
ZIP 30909-868
Phone: (706) 863-9595
Fax: (888) 745-3917

The NPI 1417924028 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/2/2006 and was last updated on 6/3/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AS0400X	Physician Assistant	Surgical	PA-1765	IDAHO	No
2	363AS0400X	Physician Assistant	Surgical	PA1198	SOUTH CAROLINA	No
3	363AS0400X	Physician Assistant	Surgical	PA0000001669	TENNESSEE	No
4	363AS0400X	Physician Assistant	Surgical	PA9106353	FLORIDA	No
5	363AS0400X	Physician Assistant	Surgical	4292	GEORGIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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