Individual
BLANCA ODALYS LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
250 MARTIN LUTHER KING JR BLVD, MACON, GA 31201-3490
(478) 301-4111
(478) 301-5812
Mailing address
PO BOX 4947, MACON, GA 31208-4947
(478) 301-2362
(478) 301-2272
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
044522
GA
Other
Enumeration date
02/12/2007
Last updated
04/11/2016
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