Provider Demographics
NPI:1316032881
Name:LORENZO, SAMUEL (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:LORENZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:290 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9069
Mailing Address - Country:US
Mailing Address - Phone:678-284-6300
Mailing Address - Fax:678-284-6336
Practice Address - Street 1:1360 UPPER HEMBREE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1171
Practice Address - Country:US
Practice Address - Phone:678-672-5100
Practice Address - Fax:678-672-5101
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA32235207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000408196RMedicaid
GA000408196RMedicaid
GA511I930099Medicare PIN