Provider Demographics
NPI:1336107978
Name:VILLANUEVA, LEMUEL G (MD)
Entity Type:Individual
Prefix:
First Name:LEMUEL
Middle Name:G
Last Name:VILLANUEVA
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 1:766 WALTHER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8765
Mailing Address - Country:US
Mailing Address - Phone:770-963-2485
Mailing Address - Fax:770-995-5381
Practice Address - Street 1:766 WALTHER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8765
Practice Address - Country:US
Practice Address - Phone:770-963-2485
Practice Address - Fax:770-995-5381
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01083816A207V00000X
GA47375207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00867292AMedicaid
IN300085901Medicaid
GA16BDTJPMedicare ID - Type UnspecifiedINDIVIDUAL #
GAGRP3635Medicare ID - Type UnspecifiedGROUP #