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Individual

DR. LILLETTE A. INTAPHAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
657 HEMLOCK ST., STE 221, MACON, GA 31201
(478) 750-8984
(478) 746-1530
Mailing address
PO BOX 786, MACON, GA 31202-0786
(478) 750-8984
(478) 746-1530

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
033601
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00742561
RR MDC
GA
Enumeration date
06/19/2006
Last updated
03/10/2014
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