Provider Demographics
NPI:1255694253
Name:LUTHRA, PALLAVI (DO)
Entity Type:Individual
Prefix:
First Name:PALLAVI
Middle Name:
Last Name:LUTHRA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:CARDIOVASCULAR CONSULTANT OF SOUTH GEORGIA
Mailing Address - Street 2:1 SWEET BAY CT
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768
Mailing Address - Country:US
Mailing Address - Phone:229-584-5570
Mailing Address - Fax:229-227-9642
Practice Address - Street 1:115 31ST AVE SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768
Practice Address - Country:US
Practice Address - Phone:229-890-5305
Practice Address - Fax:229-890-5307
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA080837207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty