MEDICARE: REBECCA LANTZ LIC. AC.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	171100000X	Acupuncturist	313	GA

General Provider Information

NPI Number	:	1649565805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LANTZ LIC. AC.

Provider Business Mailing Address
First Line	:	3802 NORTH DRUID HILLS RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033
Country	:	US
Telephone Number	:	404-486-9644
Fax Number	:

Provider Business Practice Location Address
First Line	:	3802 NORTH DRUID HILLS RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033
Country	:	US
Telephone Number	:	404-486-9644
Fax Number	:

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

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	07/23/2018

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Directions to “ REBECCA LANTZ LIC. AC.” Practice Location

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