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Individual

MR. LESTER DARRELL LEGGETTE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-AA

Contact information

Practice address
380 HOSPITAL DR, SUITE 410, MACON, GA 31217
(478) 746-5644
(229) 434-2502
Mailing address
PO BOX 2564, MACON, GA 31203-2565
(478) 746-5644
(478) 745-4849

Taxonomy

Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
001796
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01780683
AMERIGROUP
GA
05
100001416B
GA
05
100001416C
GA
05
100001416D
GA
05
100001416E
GA
05
100001416F
GA
01
362514
WELLCARE
GA
01
580628385
TRICARE
GA
Enumeration date
11/02/2005
Last updated
06/04/2013
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