Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 30642 | GA |
NPI | 1073538682 |
---|---|
Provider Name | Dr. Roger D Lovell |
First Address | Athens, GA 30606-2783 |
Second Address | Athens, GA 30606-2783 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 04/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E30749 | (02) | NC |