Individual
ANTONIO M DE LA LUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
777 HEMLOCK ST, MSC10, MACON, GA 31201-2102
(478) 633-1146
Mailing address
2490 RIVERSIDE DR, STE B, MACON, GA 31204-1787
(478) 633-6633
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
28967
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00361391D
—
GA
Enumeration date
09/11/2006
Last updated
07/31/2014
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