Provider Demographics
NPI:1205832227
Name:LENTZ, RANDY (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:
Last Name:LENTZ
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 1:182 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-0401
Mailing Address - Country:US
Mailing Address - Phone:912-385-2102
Mailing Address - Fax:912-385-2180
Practice Address - Street 1:182 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0401
Practice Address - Country:US
Practice Address - Phone:912-385-2102
Practice Address - Fax:912-385-2180
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000920323AMedicaid
GAH46326Medicare UPIN
GA000920323AMedicaid