Provider Demographics
NPI:1235264342
Name:LENTZ, JOHN DAVID III (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:LENTZ
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:2878 FIVE FORKS TRICKUM RD
Mailing Address - Street 2:STE 2A
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5896
Mailing Address - Country:US
Mailing Address - Phone:770-979-1544
Mailing Address - Fax:770-979-5662
Practice Address - Street 1:1800 TREE LANE RD
Practice Address - Street 2:STE 290A
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078
Practice Address - Country:US
Practice Address - Phone:770-979-1544
Practice Address - Fax:770-979-5662
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2019-04-12
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Provider Licenses
StateLicense IDTaxonomies
GA017573207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D70538Medicare UPIN
08BBRRNMedicare ID - Type Unspecified