Provider Demographics
NPI:1437197761
Name:ROY, DEANNA LYNNE (MD)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYNNE
Last Name:ROY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1505 LILBURN STONE MOUNTAIN RD
Mailing Address - Street 2:STE 100
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-1857
Mailing Address - Country:US
Mailing Address - Phone:770-469-4131
Mailing Address - Fax:770-469-3931
Practice Address - Street 1:1505 LILBURN STONE MOUNTAIN RD
Practice Address - Street 2:STE 100
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-1857
Practice Address - Country:US
Practice Address - Phone:770-469-4131
Practice Address - Fax:770-469-3931
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA34701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000469301JMedicaid
E88105Medicare UPIN
GA000469301JMedicaid