Organization
LILLETTE A INTAPHAN MD LLC
Active
Organization
LILLETTE A INTAPHAN MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LILLETTE A INTAPHAN (MDC)
(478) 475-1299
Entity
Organization
Contact information
Practice address
432 POPLAR ST, SUITE B, MACON, GA 31201-3336
(478) 475-1299
(478) 405-7928
Mailing address
PO BOX 26040, MACON, GA 31221-6040
(478) 475-1299
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
033601
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DP2683
RR MDC
GA
Enumeration date
04/22/2009
Last updated
10/19/2009
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