Provider Demographics
NPI:1033145925
Name:LENTZ, MONIQUE HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:HOWARD
Last Name:LENTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 WHEELER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6549
Mailing Address - Country:US
Mailing Address - Phone:706-855-7784
Mailing Address - Fax:706-650-1090
Practice Address - Street 1:3633 WHEELER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6544
Practice Address - Country:US
Practice Address - Phone:706-855-7784
Practice Address - Fax:706-650-1090
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0436862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00904098AMedicaid
GAH37227Medicare UPIN
GA00904098AMedicaid