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General NPI Number Information
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NPI Number | 1093937484
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Entity Type | Individual
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Provider Name | JUDITH GRACE LUTUMBA
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 5955 JIMMY CARTER BLVD
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City | NORCROSS
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State | GA
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Zip | 30071-4641
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Country | US
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Telephone | 770-559-3555
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Fax |
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Provider Business Mailing Address
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Address Line | 5955 JIMMY CARTER BLVD STE 100
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City | NORCROSS
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State | GA
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Zip | 30071-4608
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Country | US
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Telephone | 770-559-3555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | RN155534
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN55534
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License Number State | GA
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