MEDICARE: CHARLES LUTHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367H00000X	Anesthesiologist Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134485972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES LUTHER

Provider Business Mailing Address
First Line	:	4295 COUNTRY GARDEN WALK NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30152-2399
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4295 COUNTRY GARDEN WALK NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30152-2399
Country	:	US
Telephone Number	:	401-301-7218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2012
Last Update Date	:	04/05/2012

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Directions to “ CHARLES LUTHER ” Practice Location

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