Healthcare Provider Details

I. General information

NPI: 1225188972
Provider Name (Legal Business Name): CARLTON A LUE, MD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 PERRY HOUSE RD SUITE A
FITZGERALD GA
31750-8721
US

IV. Provider business mailing address

PO BOX 369
FITZGERALD GA
31750-0369
US

V. Phone/Fax

Practice location:
  • Phone: 229-424-7331
  • Fax: 229-424-7328
Mailing address:
  • Phone: 229-424-7331
  • Fax: 229-424-7328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number042340
License Number StateGA

VIII. Authorized Official

Name: CARLTON A LUE
Title or Position: OWNER
Credential: M.D.
Phone: 229-424-7331