Individual
LYDIA JEAN BOTTENFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1201 GEORGIAN PARK, PEACHTREE CITY, GA 30269-6972
(770) 631-4873
Mailing address
1201 GEORGIAN PARK, PEACHTREE CITY, GA 30269-6972
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10793
GA
Other
Enumeration date
01/06/2022
Last updated
01/06/2022
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