Provider Demographics
NPI:1417126616
Name:LENTZ, GEORGE R SR (EDD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:R
Last Name:LENTZ
Suffix:SR
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 COOK RD
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-9305
Mailing Address - Country:US
Mailing Address - Phone:336-329-8562
Mailing Address - Fax:
Practice Address - Street 1:553 COOK RD
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-9305
Practice Address - Country:US
Practice Address - Phone:336-329-8562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2750171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator