1497759039 NPI number — DR. FRANK LOPEZ M.D.

Table of content: MRS. SALLY MARIE WAGNER PTA (NPI 1497951305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497759039 NPI number — DR. FRANK LOPEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ
Provider First Name:
FRANK
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497759039
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 COLLIER RD NW
Provider Second Line Business Mailing Address:
STE 4075
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30309-1751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-603-3543
Provider Business Mailing Address Fax Number:
404-350-8795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 MOUNTAINSIDE VILLAGE PKWY
Provider Second Line Business Practice Location Address:
BLDG 500
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30143-8694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-253-7340
Provider Business Practice Location Address Fax Number:
706-253-7342
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  030132 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00354527C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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