Provider Demographics
NPI:1841209665
Name:LANTZ, DAVID ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:LANTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:631 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:770-962-4895
Mailing Address - Fax:770-237-9404
Practice Address - Street 1:631 PROFESSIONAL DR
Practice Address - Street 2:SUITE 360
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:770-962-4895
Practice Address - Fax:770-237-9404
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA23623207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000889655AMedicaid
GA06BDGLK07Medicare ID - Type Unspecified
GA000889655AMedicaid