Provider Demographics
NPI:1669494126
Name:DENTON, LORA C (MD)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:C
Last Name:DENTON
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 1:1101 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-5502
Mailing Address - Country:US
Mailing Address - Phone:912-350-7171
Mailing Address - Fax:912-350-3454
Practice Address - Street 1:1101 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-5502
Practice Address - Country:US
Practice Address - Phone:912-350-7171
Practice Address - Fax:912-350-3454
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110214367OtherRR MEDICARE
GA349749OtherWELLCARE
SCG33818Medicaid
GA10064375OtherAMERIGROUP
GA000511618JMedicaid
GA10064375OtherAMERIGROUP
GA110214367OtherRR MEDICARE