Healthcare Provider Details

I. General information

NPI: 1346252111
Provider Name (Legal Business Name): SUZANNE LEE LOWRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 BOB ARNOLD BLVD SUITE A
LITHIA SPRINGS GA
30122-3258
US

IV. Provider business mailing address

PO BOX 727
LITHIA SPRINGS GA
30122-0727
US

V. Phone/Fax

Practice location:
  • Phone: 770-732-2959
  • Fax: 770-732-2947
Mailing address:
  • Phone: 770-732-2959
  • Fax: 770-732-2947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number035462
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier441300
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerBLUE CROSS BLUE SHIELD
# 2
Identifier7403703
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerUNITED HEALTHCARE
# 3
Identifier58 2131709
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerTAX ID
# 4
Identifier00503456C
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: