MEDICARE: DR. SIBO TIAN 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	390200000X	Student in an Organized Health Care Education/Training Program	T40137090011872	NJ
2	2085R0001X	Radiation Oncology Physician	007978	GA

General Provider Information

NPI Number	:	1861887317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIBO TIAN M.D.

Provider Business Mailing Address
First Line	:	100 WOODRUFF CIR NE
Second Line	:	SUITE 327 SCHOOL OF MEDICINE BUILDING
City	:	ATLANTA
State	:	GA
Zip	:	30322-1020
Country	:	US
Telephone Number	:	404-727-5658
Fax Number	:	404-727-3744

Provider Business Practice Location Address
First Line	:	100 WOODRUFF CIR NE
Second Line	:	SUITE 327 SCHOOL OF MEDICINE BUILDING
City	:	ATLANTA
State	:	GA
Zip	:	30322-1020
Country	:	US
Telephone Number	:	404-727-5658
Fax Number	:	404-727-3744

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

Provider Enumeration Date	:	04/01/2015
Last Update Date	:	04/18/2016

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