Provider Demographics
NPI:1861173080
Name:MEJIA, LUIS DAVID
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:DAVID
Last Name:MEJIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 CYPRESS FALL CIR
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-2881
Mailing Address - Country:US
Mailing Address - Phone:912-237-9196
Mailing Address - Fax:
Practice Address - Street 1:103 W GENERAL SCREVEN WAY
Practice Address - Street 2:STE G PMB 1098
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313
Practice Address - Country:US
Practice Address - Phone:912-237-9196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician