Basic Information
| Provider Information | |||||||||
| NPI: | 1003001843 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUECHINGER | ||||||||
| FirstName: | INGE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRNPMH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1269 PARKER RD SE | ||||||||
| Address2: | |||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300945957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784384233 | ||||||||
| FaxNumber: | 7707619070 | ||||||||
| Practice Location | |||||||||
| Address1: | 1269 PARKER RD SE | ||||||||
| Address2: | |||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300945957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784384733 | ||||||||
| FaxNumber: | 7707619070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2007 | ||||||||
| LastUpdateDate: | 12/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0808X | RN079843 CNS/PMH | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 609588713A | 05 | GA | MEDICAID |