Provider Demographics
NPI:1073538682
Name:LOVELL, ROGER D (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:D
Last Name:LOVELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 PRINCE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2783
Mailing Address - Country:US
Mailing Address - Phone:770-670-7245
Mailing Address - Fax:706-612-1314
Practice Address - Street 1:1270 PRINCE AVE STE 301
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2783
Practice Address - Country:US
Practice Address - Phone:770-670-7245
Practice Address - Fax:706-612-1314
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30642207RI0200X
NC9800318207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1122FOtherNCBCBS
NC891122FMedicaid
SCG30642Medicaid
NCE30749Medicare UPIN
SCG30642Medicaid
NC1122FOtherNCBCBS
NCNC3864AMedicare PIN
NC2234917Medicare PIN