Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Prof. John Mark Lidell, MMSC, PA-C

Individual provider Physician Assistant · NPI 1962487538

Prof. John Mark Lidell, MMSC, PA-C is a Physician Assistant in McDonough, Georgia. Qualified in 1996, 30 years ago. Practices with Wellstar Medical Group LLC, a 3,072-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
30
Licensed in
GA
In the registry since
2005
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

101 Regency Park Dr Ste 110
McDonough, GA 30253-7076
Phone: (404) 996-0126
Fax: (678) 432-2626
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional 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

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 002952 (GA)

Record details

NPI number1962487538
Entity typeIndividual (Type 1)
GenderMale
Credentials MMSC , PA-C
Sole proprietorNo
NPI enumeratedDecember 7, 2005
Last updated in NPPESOctober 27, 2021
Certification dateOctober 27, 2021

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1996 (30 years in practice)
Group practice Wellstar Medical Group Llc — 3072 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations7 on file with Medicare

Other providers in McDonough