Provider Demographics
NPI:1346319308
Name:LORENZ, TIMOTHY CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CHRISTOPHER
Last Name:LORENZ
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 1:155 RIVER PARK XING
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-7801
Mailing Address - Country:US
Mailing Address - Phone:770-924-9858
Mailing Address - Fax:770-924-9946
Practice Address - Street 1:155 RIVER PARK XING
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7801
Practice Address - Country:US
Practice Address - Phone:770-924-9858
Practice Address - Fax:770-924-9946
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048908208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000869459DMedicaid
G69112Medicare UPIN