MEDICARE: DR. RICHARD EVERETT LORENZ 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	208200000X	Plastic Surgery Physician	052779	GA

General Provider Information

NPI Number	:	1568567642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD EVERETT LORENZ M.D.

Provider Business Mailing Address
First Line	:	1420 NORTHCLIFF TRCE
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-3275
Country	:	US
Telephone Number	:	404-374-5540
Fax Number	:

Provider Business Practice Location Address
First Line	:	3379 PEACHTREE RD NE
Second Line	:	SUITE 800
City	:	ATLANTA
State	:	GA
Zip	:	30326-1031
Country	:	US
Telephone Number	:	404-266-1212
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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