Healthcare Provider Details

I. General information

NPI: 1053369249
Provider Name (Legal Business Name): JULIA S. LUPA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 OLD NORCROSS RD SUITE 305
LAWRENCEVILLE GA
30046
US

IV. Provider business mailing address

771 OLD NORCROSS RD SUITE 305
LAWRENCEVILLE GA
30046
US

V. Phone/Fax

Practice location:
  • Phone: 770-339-4000
  • Fax: 770-339-9037
Mailing address:
  • Phone: 770-339-4000
  • Fax: 770-339-9037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN072457
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: