Provider Demographics
NPI:1568475515
Name:HOROWITZ, LONNY EVAN (MD)
Entity type:Individual
Prefix:DR
First Name:LONNY
Middle Name:EVAN
Last Name:HOROWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7914 HIGHWAY 92
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5238
Mailing Address - Country:US
Mailing Address - Phone:770-393-3438
Mailing Address - Fax:770-926-0059
Practice Address - Street 1:7914 HIGHWAY 92
Practice Address - Street 2:SUITE 110
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5238
Practice Address - Country:US
Practice Address - Phone:770-393-3438
Practice Address - Fax:770-926-0059
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA25696207Q00000X, 207R00000X, 207RE0101X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD40178Medicare UPIN