Individual
JOHN ROMAN LUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
240 CREEKSTONE RDG, WOODSTOCK, GA 30188-3732
(770) 592-9065
(770) 592-9095
Mailing address
190 IRONWOOD RD, CANTON, GA 30114-6118
(770) 704-7510
(770) 592-9095
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY001726
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000515171C
—
GA
Enumeration date
11/25/2006
Last updated
08/15/2007
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