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DORNER LEE CARMICHAEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
764 PINE ST, MACON, GA 31201-2107
(478) 633-1696
(478) 633-2316
Mailing address
598 3RD ST, MACON, GA 31201-3357
(478) 633-6706
(478) 633-5384

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
000211
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100001881A
GA
01
970011438
RAIL ROAD MEDICARE
GA
Enumeration date
03/20/2006
Last updated
03/07/2023
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