Provider Demographics
NPI:1346252111
Name:LOWRY, SUZANNE LEE (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LEE
Last Name:LOWRY
Suffix:
Gender:F
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:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-0727
Mailing Address - Country:US
Mailing Address - Phone:770-732-2959
Mailing Address - Fax:770-732-2947
Practice Address - Street 1:939 BOB ARNOLD BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-3258
Practice Address - Country:US
Practice Address - Phone:770-732-2959
Practice Address - Fax:770-732-2947
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035462207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA441300OtherBLUE CROSS BLUE SHIELD
GA7403703OtherUNITED HEALTHCARE
GA58 2131709OtherTAX ID
GA00503456CMedicaid
GA16BDDQQMedicare ID - Type Unspecified