Provider Demographics
NPI:1376762674
Name:LAMM, MAUREEN ANN (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANN
Last Name:LAMM
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 1:2890 DELK RD SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5326
Mailing Address - Country:US
Mailing Address - Phone:770-955-0377
Mailing Address - Fax:
Practice Address - Street 1:2890 DELK RD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5326
Practice Address - Country:US
Practice Address - Phone:770-955-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G66312Medicare UPIN
173050155Medicare ID - Type Unspecified