Healthcare Provider Details

I. General information

NPI: 1285637231
Provider Name (Legal Business Name): CARLOS E LOPEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 COLLIER RD NW STE 450
ATLANTA GA
30309-1709
US

IV. Provider business mailing address

275 COLLIER RD NW STE 450
ATLANTA GA
30309-1709
US

V. Phone/Fax

Practice location:
  • Phone: 404-355-3161
  • Fax: 404-355-1353
Mailing address:
  • Phone: 404-355-3161
  • Fax: 404-355-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number19066
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: