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General NPI Number Information
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NPI Number | 1235264342
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Entity Type | Individual
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Provider Name | JOHN DAVID LENTZ III MD
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 04/12/2019
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Provider Practice Location Address
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Address Line | 1800 TREE LANE RD STE 290A
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City | SNELLVILLE
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State | GA
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Zip | 30078
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Country | US
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Telephone | 770-979-1544
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Fax | 770-979-5662
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Provider Business Mailing Address
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Address Line | 2878 FIVE FORKS TRICKUM RD STE 2A
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-5896
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Country | US
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Telephone | 770-979-1544
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Fax | 770-979-5662
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 017573
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License Number State | GA
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