Individual
DOREEN LUIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1350 WALTON WAY, AUGUSTA, GA 30901-2612
(706) 722-9011
Mailing address
PO BOX 532780, ATLANTA, GA 30353-2780
(800) 639-0579
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
37601
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000579785H
—
GA
Enumeration date
08/17/2006
Last updated
12/19/2007
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