NPIMap

Juan Manuel Lopez, MD

Individual provider Active NPI Plastic Surgery Physician · Fort Eisenhower, GA

NPI 1053473504 · NPPES record last updated Mar 10, 2025

Key facts

NPI
1053473504
Entity type
Individual (NPI type 1)
Primary specialty
Plastic Surgery Physician 208200000X
License
74518 (GA)
Practice address
300 W Hospital Rd
Fort Eisenhower, GA 30905-5741
Phone
(706) 787-1164
NPI assigned
Dec 14, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME74668FLMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bridget J Keller MD LLC Past Accepting new patients
Andre Renard MD PA Plastic Surgery Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X ME74668 FL
Plastic Surgery Physician 208200000X 74518 GA Yes

Addresses

Primary practice location

300 W Hospital Rd
Fort Eisenhower, GA 30905-5741

Mailing address

300 W Hospital Rd
Fort Eisenhower, GA 30905-5741
Phone (706) 787-1164

Other providers in Fort Eisenhower, GA

All providers in Fort Eisenhower, GA · Plastic Surgery Physician in Georgia

Sources for this page

Verify at the official NPI Registry.