MEDICARE: LINTON W EBERHARDT IV 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	2085R0202X	Diagnostic Radiology Physician	055123	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P01208880	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52128834022	OTHER	GA	BCBSGA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	52128834023	OTHER	GA	BCBSGA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386618130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINTON W EBERHARDT IV MD

Provider Business Mailing Address
First Line	:	60 11TH ST NE APT 1817
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-4384
Country	:	US
Telephone Number	:	770-891-2003
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 11TH ST NE APT 1817
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309
Country	:	US
Telephone Number	:	770-891-2003
Fax Number	:

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

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	06/22/2018

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