Provider Demographics
NPI:1962401570
Name:LEPOR, ROCHELLE Y (DO)
Entity type:Individual
Prefix:DR
First Name:ROCHELLE
Middle Name:Y
Last Name:LEPOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ROCHELLE
Other - Middle Name:Y
Other - Last Name:LOPEZ-LINUS LEPOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:400 TIMMS RD NE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-7016
Mailing Address - Country:US
Mailing Address - Phone:706-625-0022
Mailing Address - Fax:706-625-3803
Practice Address - Street 1:400 TIMMS RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-7016
Practice Address - Country:US
Practice Address - Phone:706-625-0022
Practice Address - Fax:706-625-3803
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA153404709AMedicaid
GA1962401570OtherNPI
I21766Medicare UPIN
GA153404709AMedicaid