Healthcare Provider Details

I. General information

NPI: 1568558062
Provider Name (Legal Business Name): LANCE L STEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW 77 BUILDING, 6TH FLOOR
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

1968 PEACHTREE RD NW 77 BUILDING, 6TH FLOOR
ATLANTA GA
30309-1281
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-2055
  • Fax: 678-244-6608
Mailing address:
  • Phone: 404-605-2055
  • Fax: 678-244-6608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number56368
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number56368
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number56368
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number56368
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: