Provider Demographics
NPI:1053369249
Name:LUPA, JULIA S (NP)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:S
Last Name:LUPA
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Gender:F
Credentials:NP
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Mailing Address - Street 1:771 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:770-339-4000
Mailing Address - Fax:770-339-9037
Practice Address - Street 1:771 OLD NORCROSS RD
Practice Address - Street 2:SUITE 305
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:770-339-4000
Practice Address - Fax:770-339-9037
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN072457363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA500030756OtherRAILROAD MEDICARE
GA963939442AMedicaid
GAP79584Medicare UPIN
GA50BBGNRMedicare ID - Type UnspecifiedGA MEDICARE PROV #