Healthcare Provider Details

I. General information

NPI: 1528328556
Provider Name (Legal Business Name): DAVID ALAN LOVEJOY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 HEMLOCK ST STE 210
MACON GA
31201-8314
US

IV. Provider business mailing address

682 HEMLOCK ST STE 210
MACON GA
31201-8314
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-5300
  • Fax: 478-633-5304
Mailing address:
  • Phone: 478-633-5300
  • Fax: 478-633-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number83363
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: