Provider Demographics
NPI:1609162965
Name:LINDUC PC
Entity Type:Organization
Organization Name:LINDUC PC
Other - Org Name:LINDUC MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:UCHENNA
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:KALU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-250-1418
Mailing Address - Street 1:2680 LAWRENCEVILLE HWY STE 202
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2526
Mailing Address - Country:US
Mailing Address - Phone:470-250-1418
Mailing Address - Fax:770-674-7626
Practice Address - Street 1:2680 LAWRENCEVILLE HWY STE 202
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2526
Practice Address - Country:US
Practice Address - Phone:470-250-1418
Practice Address - Fax:770-674-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062127207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty