Individual
JORGE L LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
900 TOWNE LAKE PKWY, SUITE 400, WOODSTOCK, GA 30189-1602
(770) 924-5095
(770) 924-7429
Mailing address
900 TOWNE LAKE PKWY, SUITE 400, WOODSTOCK, GA 30189-1602
(770) 924-5095
(770) 924-7429
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005841
GA
363A00000X
Physician Assistant
PA 9101712
FL
Other
Enumeration date
05/01/2007
Last updated
09/21/2016
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