Provider Demographics
NPI:1932177177
Name:LOPEZ, RAPHAEL (MD)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:
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 1:3180 N POINT PKWY
Mailing Address - Street 2:STE 303
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4522
Mailing Address - Country:US
Mailing Address - Phone:863-421-4400
Mailing Address - Fax:863-421-4402
Practice Address - Street 1:3180 N POINT PKWY STE 303
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4522
Practice Address - Country:US
Practice Address - Phone:678-205-9004
Practice Address - Fax:678-205-9005
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA87546207R00000X
FLME85048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265216100Medicaid
FLH71765Medicare UPIN
FL28002ZMedicare ID - Type Unspecified