Provider Demographics
NPI:1497759039
Name:LOPEZ, FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:95 COLLIER RD NW
Mailing Address - Street 2:STE 4075
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1751
Mailing Address - Country:US
Mailing Address - Phone:404-603-3543
Mailing Address - Fax:404-350-8795
Practice Address - Street 1:134 MOUNTAINSIDE VILLAGE PKWY
Practice Address - Street 2:BLDG 500
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-8694
Practice Address - Country:US
Practice Address - Phone:706-253-7340
Practice Address - Fax:706-253-7342
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2014-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA030132207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00354527CMedicaid
GAD45965Medicare UPIN
GA11SCDVZMedicare ID - Type Unspecified