Provider Demographics
NPI:1124339338
Name:LENNON, JAMES GERARD (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GERARD
Last Name:LENNON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 VILLAGE PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-2381
Mailing Address - Country:US
Mailing Address - Phone:334-528-1070
Mailing Address - Fax:
Practice Address - Street 1:2501 VILLAGE PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-2381
Practice Address - Country:US
Practice Address - Phone:334-528-1070
Practice Address - Fax:334-528-1074
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017692207R00000X
GA76106207RH0003X
AL3138207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003176314CMedicaid