Provider Demographics
NPI:1104326271
Name:LENNINGTON, MARTHA KATHERINE (PA)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:KATHERINE
Last Name:LENNINGTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:M KATHERINE
Other - Middle Name:
Other - Last Name:LENNINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:400 CHARTER BLVD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4831
Mailing Address - Country:US
Mailing Address - Phone:478-757-8200
Mailing Address - Fax:
Practice Address - Street 1:400 CHARTER BLVD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4831
Practice Address - Country:US
Practice Address - Phone:478-757-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008663363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant