Provider Demographics
NPI:1932425360
Name:LU, LYDIA S (PA-C)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:S
Last Name:LU
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1400 TULLIE RD NE FL 2
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2309
Mailing Address - Country:US
Mailing Address - Phone:404-785-5437
Mailing Address - Fax:404-785-9111
Practice Address - Street 1:1400 TULLIE RD NE FL 2
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2309
Practice Address - Country:US
Practice Address - Phone:404-785-5437
Practice Address - Fax:404-785-9111
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2022-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA5810363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant