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General NPI Number Information
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NPI Number | 1881097483
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Entity Type | Organization
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Legal Business Name | RANDY LENTZ MD
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Dates
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Enumeration Date | 09/27/2014
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Last Update Date | 09/27/2014
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Provider Practice Location Address
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Address Line | 182 SUNSET BLVD
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City | JESUP
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State | GA
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Zip | 31545-0401
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Country | US
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Telephone | 912-385-2102
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Fax |
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Provider Business Mailing Address
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Address Line | 182 SUNSET BLVD
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City | JESUP
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State | GA
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Zip | 31545-0401
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Country | US
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Telephone | 912-385-2102
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RANDY SCOTT LENTZ
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Credential | MD
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Telephone | 912-385-2102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 050500
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License Number State | GA
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