Provider Demographics
NPI:1043786841
Name:LEMON, DEMETRIUS R
Entity type:Individual
Prefix:MR
First Name:DEMETRIUS
Middle Name:R
Last Name:LEMON
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 1:2900 LAUREL RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6209
Mailing Address - Country:US
Mailing Address - Phone:470-234-9410
Mailing Address - Fax:
Practice Address - Street 1:2900 LAUREL RIDGE WAY
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6209
Practice Address - Country:US
Practice Address - Phone:470-234-9410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty