Healthcare Provider Details

I. General information

NPI: 1750934857
Provider Name (Legal Business Name): LINDUC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 05/15/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 LAWRENCEVILLE HWY STE 202
DECATUR GA
30033-2526
US

IV. Provider business mailing address

2680 LAWRENCEVILLE HWY STE 202
DECATUR GA
30033-2526
US

V. Phone/Fax

Practice location:
  • Phone: 470-250-1418
  • Fax: 770-674-7626
Mailing address:
  • Phone: 470-250-1418
  • Fax: 770-674-7626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: UCHENNA PETER KALU
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 470-250-1418