Provider Demographics
NPI:1164461901
Name:LOVENTHAL, WILLIAM GARRETT IV (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:GARRETT
Last Name:LOVENTHAL
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:LOVENTHAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:CHILDREN'S WELLNESS CENTER 755 MT. VERNON HWY., NE
Mailing Address - Street 2:STE. 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:404-303-1314
Mailing Address - Fax:404-303-1399
Practice Address - Street 1:CHILDREN'S WELLNESS CENTER 755 MT. VERNON HWY., NE
Practice Address - Street 2:STE. 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:404-303-1314
Practice Address - Fax:404-303-1399
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048536208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00879183AMedicaid