MEDICARE: MR. LUKE LENAHAN

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	363AS0400X	Surgical Physician Assistant	7436	GA
2	363AM0700X	Medical Physician Assistant	7436	GA

General Provider Information

NPI Number	:	1174922751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUKE LENAHAN

Provider Business Mailing Address
First Line	:	3931 MUNDY MILL RD STE A
Second Line	:
City	:	OAKWOOD
State	:	GA
Zip	:	30566-3431
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3931 MUNDY MILL RD STE A
Second Line	:
City	:	OAKWOOD
State	:	GA
Zip	:	30566-3431
Country	:	US
Telephone Number	:	770-219-8275
Fax Number	:

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

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	05/15/2025

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Directions to “ MR. LUKE LENAHAN ” Practice Location

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