Basic Information
| Provider Information | |||||||||
| NPI: | 1538443411 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORAVIA | ||||||||
| FirstName: | LUCIE | ||||||||
| MiddleName: | VICTORIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 PEACHTREE ST NE STE 1275 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303082240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048723121 | ||||||||
| FaxNumber: | 4048723119 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 PEACHTREE ST NE STE 1275 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303082240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048723121 | ||||||||
| FaxNumber: | 4048723119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2011 | ||||||||
| LastUpdateDate: | 03/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | OS016383 | PA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 66951 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 003114498B | 05 | GA | MEDICAID | 003114498E | 05 | GA | MEDICAID | 003114498H | 05 | GA | MEDICAID | 3007279 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 003114498D | 05 | GA | MEDICAID | 102868764 | 05 | PA | MEDICAID | 003114498F | 05 | GA | MEDICAID | 003114498C | 05 | GA | MEDICAID | 003114498G | 05 | GA | MEDICAID |