Provider Demographics
NPI:1124095542
Name:LOKEY, JOHN L (PA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:LOKEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 SHRINE RD STE 290
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4785
Mailing Address - Country:US
Mailing Address - Phone:912-466-7470
Mailing Address - Fax:912-466-4209
Practice Address - Street 1:3025 SHRINE RD STE 290
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4785
Practice Address - Country:US
Practice Address - Phone:912-466-7470
Practice Address - Fax:912-466-4209
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3071363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01068897OtherAMERIGROUP
GA100002117KMedicaid
GA100002117BMedicaid
GA100002117DMedicaid
GA01068897OtherAMERIGROUP
GA100002117BMedicaid
GA100002117EMedicaid