Basic Information
Provider Information
NPI: 1003001843
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LUECHINGER
FirstName: INGE
MiddleName: C
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1269 PARKER RD SE
Address2: SUITE 3D
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: 06/29/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
364SP0808XRN079843 CNS/PMHGAY Physician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsych/Mental Health

ID Information
IDTypeStateIssuerDescription
609588713A05GA MEDICAID


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