Organization
PEDIATRICS OF GLYNN ON THE ISLAND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA C LUMPKIN (PRACTICE MANAGER)
(912) 634-2795
Entity
Organization
Contact information
Practice address
172 FOLLINS LN, ST SIMONS ISLAND, GA 31522-4268
(912) 634-2795
(912) 638-5636
Mailing address
172 FOLLINS LN, ST SIMONS ISLAND, GA 31522-4268
(912) 634-2795
(912) 638-5636
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00672977B
—
GA
05
—
00760966B
—
GA
01
—
10065447
LEE HEERY AMERIGROUP
GA
01
—
10066660
CAROLE LYONS AMERIGROUP #
GA
01
—
10066698
OWEN AMERIGROUP#
GA
01
—
12545338912
CAROLE LYONS NPI
GA
01
—
1699873299
LEE HEERY NPI#
GA
01
—
335886
CAROLE LYONS WELLCARE#
GA
01
—
335898
OWEN WELLCARE#
GA
01
—
365007
LEE HEERY WELLCARE #
GA
01
—
963103
FRANCES OWEN BCBS #
GA
01
—
969118
LEE HEERY BCBS GA #
GA
Enumeration date
04/02/2007
Last updated
08/22/2020
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