Provider Demographics
NPI:1962554451
Name:MONROE, LEMONT C SR
Entity type:Individual
Prefix:MR
First Name:LEMONT
Middle Name:C
Last Name:MONROE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LEMONT
Other - Middle Name:
Other - Last Name:MONROE
Other - Suffix:X
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:1916 N LEG RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-4402
Mailing Address - Country:US
Mailing Address - Phone:706-667-4283
Mailing Address - Fax:706-729-2053
Practice Address - Street 1:1916 N LEG RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-4402
Practice Address - Country:US
Practice Address - Phone:706-667-4283
Practice Address - Fax:706-729-2053
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN045602164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse