Provider Demographics
NPI:1295613693
Name:LUMENMED LLC
Entity type:Organization
Organization Name:LUMENMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:UDAY
Authorized Official - Middle Name:
Authorized Official - Last Name:TATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-571-0899
Mailing Address - Street 1:2138 SCENIC HWY N STE A
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6106
Mailing Address - Country:US
Mailing Address - Phone:678-571-0899
Mailing Address - Fax:
Practice Address - Street 1:2138 SCENIC HWY N STE A
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6106
Practice Address - Country:US
Practice Address - Phone:678-571-0899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-25
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty