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General NPI Number Information
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NPI Number | 1184993578
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Entity Type | Organization
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Legal Business Name | INTOWN INFECTIOUS DISEASES, LLC
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 619 RANKIN ST NE
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City | ATLANTA
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State | GA
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Zip | 30308-2920
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Country | US
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Telephone | 404-805-6062
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Fax |
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Provider Business Mailing Address
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Address Line | 1961 OAK GROVE RD NE
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City | ATLANTA
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State | GA
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Zip | 30345-3840
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Country | US
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Telephone | 404-805-6062
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SOPHIE A LUKASHOK
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Credential | M.D.
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Telephone | 404-805-6062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 44010
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License Number State | GA
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