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General NPI Number Information
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NPI Number | 1225188972
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Entity Type | Organization
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Legal Business Name | CARLTON A LUE, MD,PC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 182 PERRY HOUSE RD SUITE A
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City | FITZGERALD
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State | GA
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Zip | 31750-8721
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Country | US
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Telephone | 229-424-7331
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Fax | 229-424-7328
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Provider Business Mailing Address
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Address Line | PO BOX 369
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City | FITZGERALD
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State | GA
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Zip | 31750-0369
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Country | US
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Telephone | 229-424-7331
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Fax | 229-424-7328
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Authorized Official
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Title or Position | OWNER
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Name | CARLTON A LUE
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Credential | M.D.
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Telephone | 229-424-7331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 042340
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License Number State | GA
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