Provider Demographics
NPI:1033110598
Name:LAMA, JUAN A (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:A
Last Name:LAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:150 MEDICAL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5053
Mailing Address - Country:US
Mailing Address - Phone:770-389-9944
Mailing Address - Fax:770-389-1973
Practice Address - Street 1:150 MEDICAL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5053
Practice Address - Country:US
Practice Address - Phone:770-389-9944
Practice Address - Fax:770-389-1973
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA033380208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
055865OtherBCBS
274907OtherAETNA
7804OtherKAISER
S06119OtherSC HEALTHSOURCE
055865OtherFEP/BLUE CROSS BLUE SHIEL
581487734003OtherPRUCARE
0110001567OtherHEALTH SOURCE
0928045OtherAETNA SELECT/US HEALTHC
7804OtherKAISER POS
1202800OtherUNITED HEALTHCARE