John Mark Lidell, M.M.SC. , PA-C

Physician Assistant · McDonough, GA

Individual Active NPI

NPI number 1962487538

Practice location

101 Regency Park Dr Ste 110
McDonough, GA 30253-7076
Phone
(404) 996-0126
Fax
(678) 432-2626

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NPI record

NPI
1962487538
Entity type
Individual (Type 1)
Enumeration date
December 7, 2005
Last updated
October 27, 2021
Certified
October 27, 2021
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Physician Assistant Primary 363A00000X 002952 GA

Mailing address

3576 Highway 138 SE
Stockbridge, GA 30281-7909
Phone
(770) 474-7448
Fax
(770) 474-7194

Other practice locations (2)

  • 913 Eagles Landing Pkwy Ste 150, Stockbridge, GA 30281-5011 · (770) 692-5910
  • 3576 Highway 138 SE, Stockbridge, GA 30281-7909 · (770) 474-7448

About John Lidell

John Mark Lidell, M.M.SC. , PA-C is a healthcare provider registered in the NPI registry with the primary taxonomy Physician Assistant (code 363A00000X). The practice location is 101 Regency Park Dr Ste 110, McDonough, GA 30253-7076. The NPI number 1962487538 was assigned on December 7, 2005 and the record was last updated on October 27, 2021.

John Lidell lists a license in the registry: #002952 (GA) for Physician Assistant. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of John Mark Lidell, M.M.SC. , PA-C?

The NPI number is 1962487538.

What is the phone number of John Lidell?

The phone number listed for the practice location is (404) 996-0126.

Where is John Lidell located?

101 Regency Park Dr Ste 110, McDonough, GA 30253-7076.

What is the taxonomy code for John Lidell?

The primary taxonomy code is 363A00000X – Physician Assistant.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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