Organization · NPI-2

Randy Lentz MD

Clinic/Center · Jesup, GA

NPI number1881097483
StatusActive
Last updated in NPPESSep 27, 2014

Details

NPI
1881097483
Entity type
Organization (NPI-2)
Legal business name
Randy Lentz MD
Organization subpart
No
Enumeration date
Sep 27, 2014
Last updated
Sep 27, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center050500GAYes

Practice location

182 Sunset Blvd
Jesup, GA 31545-0401

Phone 912-385-2102

Mailing address

182 Sunset Blvd
Jesup, GA 31545-0401

Phone 912-385-2102

Authorized official

Randy Scott Lentz
Physician
9123852102

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