Active NPI
Jorge L Lopez, PAC
- Physician Assistant
- Woodstock, GA
National Provider Identifier
1316167398
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 005841
- Practice address
- 900 Towne Lake Pkwy
Suite 400
Woodstock, GA 30189-1602 - Phone
- (770) 924-5095
- Fax
- (770) 924-7429
- NPI assigned
- May 1, 2007
- Last updated
- Sep 21, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA 9101712 | FL | |
| Physician Assistant | 363A00000X | 005841 | GA | Primary |
Addresses
Primary practice location
900 Towne Lake Pkwy
Suite 400
Woodstock, GA 30189-1602
Mailing address
900 Towne Lake Pkwy
Suite 400
Woodstock, GA 30189-1602
Phone (770) 924-5095
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA 9101712 | FL | MD | Physician Assistant |
| 005841 | GA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474416000000",
"number": "1316167398",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 TOWNE LAKE PKWY",
"address_2": "SUITE 400",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301891602",
"telephone_number": "770-924-5095",
"fax_number": "770-924-7429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 TOWNE LAKE PKWY",
"address_2": "SUITE 400",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301891602",
"telephone_number": "770-924-5095",
"fax_number": "770-924-7429"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ",
"first_name": "JORGE",
"middle_name": "L",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-01",
"last_updated": "2016-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA 9101712",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "005841",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodstock, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.