Provider Demographics
NPI:1750801619
Name:LANKA, HEMATHEJA
Entity type:Individual
Prefix:
First Name:HEMATHEJA
Middle Name:
Last Name:LANKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HOSPITAL PARK
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6772
Mailing Address - Country:US
Mailing Address - Phone:229-985-3003
Mailing Address - Fax:
Practice Address - Street 1:9 HOSPITAL PARK
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6772
Practice Address - Country:US
Practice Address - Phone:229-985-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program