Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kevin Lack, PA-C

Individual provider Surgical Physician Assistant · NPI 1417924028

Kevin Lack, PA-C is a Physician Assistant in Augusta, Georgia. Qualified in 2004, 22 years ago. Practices with Joseph M Still Burn Centers, Inc, a 47-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Florida, Georgia, Idaho and South Carolina and 1 more.

Years since qualifying
22
Licensed in
FL, GA, ID, SC, TN
In the registry since
2006
Specialties on file
5
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

3675 J Dewey Gray Cir Ste 300
Augusta, GA 30909-1868
Phone: (706) 863-9595
Fax: (888) 745-3917
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3651 Wheeler Rd, Augusta, GA 30909-6521 — (706) 863-9595

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 4292 (GA)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence PA-1765 (ID)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence PA1198 (SC)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence PA0000001669 (TN)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence PA9106353 (FL)

Record details

NPI number1417924028
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMarch 2, 2006
Last updated in NPPESMarch 10, 2025
Certification dateMarch 10, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Joseph M Still Burn Centers, Inc — 47 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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