Provider Demographics
NPI:1225188972
Name:CARLTON A LUE, MD,PC
Entity Type:Organization
Organization Name:CARLTON A LUE, MD,PC
Other - Org Name:INTERNAL MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-424-7331
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-0369
Mailing Address - Country:US
Mailing Address - Phone:229-424-7331
Mailing Address - Fax:229-424-7328
Practice Address - Street 1:182 PERRY HOUSE RD
Practice Address - Street 2:SUITE A
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-8721
Practice Address - Country:US
Practice Address - Phone:229-424-7331
Practice Address - Fax:229-424-7328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042340173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA330401Medicaid
GA00720376AMedicaid
GA330401Medicaid
GA00720376AMedicaid