Provider Demographics
NPI:1861440216
Name:LOPEZ, ALVARO J (MD)
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:J
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 HOSPITAL SOUTH DR STE 402
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8116
Mailing Address - Country:US
Mailing Address - Phone:770-739-8282
Mailing Address - Fax:
Practice Address - Street 1:1370 MONTREAL RD
Practice Address - Street 2:#130
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-8128
Practice Address - Country:US
Practice Address - Phone:770-939-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA34184207RI0200X
GA034184174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00476704AMedicaid
GA44ZCBSKMedicare ID - Type Unspecified
GAE78993Medicare UPIN