Basic Information
| Provider Information | |||||||||
| NPI: | 1043228364 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROLLINS III MD | ||||||||
| FirstName: | LUTHER | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1140 HAMMOND DRIVE, NE | ||||||||
| Address2: | BLDG D-4190 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705588501 | ||||||||
| FaxNumber: | 7705588512 | ||||||||
| Practice Location | |||||||||
| Address1: | 1140 HAMMOND DRIVE, NE | ||||||||
| Address2: | BLDG D-4190 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043511745 | ||||||||
| FaxNumber: | 4043517121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 09/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 023101 | GA | N | Other Service Providers | Specialist | 207L00000X | 023101 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | 023101 | GA | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 023101 | 01 | GA | LICENSE | OTHER | LICENSE | 01 | GA | 023101 | OTHER | 000281652A | 05 | GA | MEDICAID |