Healthcare Provider Details

I. General information

NPI: 1033110598
Provider Name (Legal Business Name): JUAN A LAMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MEDICAL BLVD SUITE B
STOCKBRIDGE GA
30281-5053
US

IV. Provider business mailing address

150 MEDICAL BLVD SUITE B
STOCKBRIDGE GA
30281-5053
US

V. Phone/Fax

Practice location:
  • Phone: 770-389-9944
  • Fax: 770-389-1973
Mailing address:
  • Phone: 770-389-9944
  • Fax: 770-389-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number033380
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: