Healthcare Provider Details

I. General information

NPI: 1215993118
Provider Name (Legal Business Name): PAUL LU TSO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WOODRUFF CIRCLE ROOM 5105 WMB
ATLANTA GA
30322-0001
US

IV. Provider business mailing address

101 WOODRUFF CIRCLE ROOM 5105 WMB
ATLANTA GA
30322-0001
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-9942
  • Fax: 404-727-3660
Mailing address:
  • Phone: 404-727-9942
  • Fax: 404-727-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number047547
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: