Healthcare Provider Details

I. General information

NPI: 1811946593
Provider Name (Legal Business Name): LENUS LOUIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12970 HIGHWAY 9 N
MILTON GA
30004-3609
US

IV. Provider business mailing address

12970 HIGHWAY 9 N
MILTON GA
30004-3609
US

V. Phone/Fax

Practice location:
  • Phone: 770-754-4115
  • Fax: 770-754-4117
Mailing address:
  • Phone: 770-754-4115
  • Fax: 770-754-4117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number048266
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: