Healthcare Provider Details

I. General information

NPI: 1508893280
Provider Name (Legal Business Name): GARY Z LOTNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2296 HENDERSON MILL RD SUITE 300
ATLANTA GA
30345
US

IV. Provider business mailing address

114 TOWNPARK DR NW SUITE 240
KENNESAW GA
30144-3715
US

V. Phone/Fax

Practice location:
  • Phone: 770-491-9300
  • Fax: 770-496-4955
Mailing address:
  • Phone: 770-952-8612
  • Fax: 678-803-6944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number020572
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: