Provider Demographics
NPI:1538443411
Name:MORAVIA, LUCIE VICTORIA (DO)
Entity type:Individual
Prefix:DR
First Name:LUCIE
Middle Name:VICTORIA
Last Name:MORAVIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ST NE STE 1275
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2240
Mailing Address - Country:US
Mailing Address - Phone:404-872-3121
Mailing Address - Fax:404-872-3119
Practice Address - Street 1:550 PEACHTREE ST NE STE 1275
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2240
Practice Address - Country:US
Practice Address - Phone:404-872-3121
Practice Address - Fax:404-872-3119
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016383207V00000X
GA66951207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003114498BMedicaid
GA003114498EMedicaid
GA003114498HMedicaid
PA3007279OtherHIGHMARK BLUE SHIELD
GA003114498DMedicaid
PA102868764Medicaid
GA003114498FMedicaid
GA003114498CMedicaid
GA003114498GMedicaid