Individual
MANDRIA L FUQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2137 LAKESIDE DR, SUITE 100, LYNCHBURG, VA 24501-6806
(434) 385-4184
(434) 385-8616
Mailing address
2137 LAKESIDE DR, SUITE 100, LYNCHBURG, VA 24501-6806
(434) 385-4184
(434) 385-8616
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002029
VA
363AM0700X
Medical Physician Assistant
104177
NC
Other
Enumeration date
08/02/2005
Last updated
08/14/2013
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