Healthcare Provider Details

I. General information

NPI: 1932166766
Provider Name (Legal Business Name): ALBERT LOSKEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST 8TH FLOOR STE 4300
ATLANTA GA
30308
US

IV. Provider business mailing address

2489 KIRKLAND DR NE
ATLANTA GA
30345
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-8143
  • Fax: 404-686-4560
Mailing address:
  • Phone: 404-636-6919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number046160
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: