MEDICARE: LISA C PERRY-GILKES 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	207Y00000X	Otolaryngology Physician	052218	GA

General Provider Information

NPI Number	:	1811989478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA C PERRY-GILKES M.D.

Provider Business Mailing Address
First Line	:	PO BOX 16968
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30321-0968
Country	:	US
Telephone Number	:	404-766-8110
Fax Number	:	404-766-8106

Provider Business Practice Location Address
First Line	:	3885 PRINCETON LAKES WAY SW
Second Line	:	SUITE 312A
City	:	ATLANTA
State	:	GA
Zip	:	30331-5589
Country	:	US
Telephone Number	:	404-766-8110
Fax Number	:	404-766-8106

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	10/04/2012

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