Healthcare Provider Details

I. General information

NPI: 1255694253
Provider Name (Legal Business Name): PALLAVI LUTHRA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 COMMERCE DR STE 108
GREENSBORO GA
30642-7444
US

IV. Provider business mailing address

PO BOX 48089
ATHENS GA
30604-8089
US

V. Phone/Fax

Practice location:
  • Phone: 706-389-3440
  • Fax: 706-353-2205
Mailing address:
  • Phone: 706-389-3740
  • Fax: 706-389-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number80837
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: