Lydia C Boggs
Individual provider Active NPI Case Manager/Care Coordinator · Waycross, GA
NPI 1407343296 · NPPES record last updated Apr 17, 2018
Key facts
- NPI
- 1407343296
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Case Manager/Care Coordinator 171M00000X
- Practice address
- 1020 Mary St
Waycross, GA 31503-3849 - Phone
- (912) 550-3382
- Fax
- (912) 287-6689
- NPI assigned
- Apr 17, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Yes |
Addresses
Primary practice location
1020 Mary St
Waycross, GA 31503-3849
Mailing address
1020 Mary Street P.O. Box 2361
Waycross, GA 31502
Phone (912) 550-3382
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | GA |
Other providers in Waycross, GA
- James Madison Blackwell
- Scotty Blanchard Jr.
- Hazel Blaylock-Lawson
- James H Bloodworth
- Bobby Bennett Host Home
- Tiffany L Bolden-Watkins
- Yolanda Machelle Borders
- Drew Robert Borgholthaus
- Deena M. Boyd
- Crystal Lynn Boyett
All providers in Waycross, GA · Case Manager/Care Coordinator in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.