MEDICARE: DR. EVE MARIE LACKRITZ M.D.

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	208000000X	Pediatrics Physician	38031	GA

General Provider Information

NPI Number	:	1477711471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVE MARIE LACKRITZ M.D.

Provider Business Mailing Address
First Line	:	4770 BUFORD HWY
Second Line	:	CDC, MAILSTOP K-23
City	:	ATLANTA
State	:	GA
Zip	:	30341-3717
Country	:	US
Telephone Number	:	770-488-6507
Fax Number	:	770-488-6283

Provider Business Practice Location Address
First Line	:	2900 WOODCOCK BLVD
Second Line	:	COLUMBIA BUILDING, KOGER CENTER
City	:	ATLANTA
State	:	GA
Zip	:	30341-4004
Country	:	US
Telephone Number	:	770-488-6507
Fax Number	:

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

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	05/27/2008

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