MEDICARE: JEFREY D LIEBERMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	031623	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366525057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFREY D LIEBERMAN MD

Provider Business Mailing Address
First Line	:	2680 LAWRENCEVILLE HWY STE 201
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-2526
Country	:	US
Telephone Number	:	404-296-4911
Fax Number	:	404-296-1512

Provider Business Practice Location Address
First Line	:	2680 LAWRENCEVILLE HWY STE 201
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-2526
Country	:	US
Telephone Number	:	404-296-4911
Fax Number	:	404-296-1512

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	05/02/2024

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