MEDICARE: LITHOTRIPSY MANAGEMENT ASSOCIATES

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	2086X0206X	Surgical Oncology Physician

General Provider Information

NPI Number	:	1639161557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITHOTRIPSY MANAGEMENT ASSOCIATES

Provider Business Mailing Address
First Line	:	750 HAMMOND DR NE
Second Line	:	BLDG 18 STE 100
City	:	ATLANTA
State	:	GA
Zip	:	30328-5532
Country	:	US
Telephone Number	:	404-255-9300
Fax Number	:	404-255-9311

Provider Business Practice Location Address
First Line	:	750 HAMMOND DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5532
Country	:	US
Telephone Number	:	404-255-9300
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. TRACY M STOLANSKI
Credential	:
Telephone Number	:	404-255-9300

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	07/31/2008

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