Provider Demographics
NPI:1104938570
Name:LUE, JOHN RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RAYMOND
Last Name:LUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 HOWELL MILL RD NW
Mailing Address - Street 2:SUITE C-357
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1732
Mailing Address - Country:US
Mailing Address - Phone:404-522-4400
Mailing Address - Fax:404-522-4403
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-2542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040145207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000660558IMedicaid
GAG10941Medicare UPIN
GA000660558IMedicaid