Healthcare Provider Details

I. General information

NPI: 1326020389
Provider Name (Legal Business Name): LIZABETH A HUMPHREY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PARKWAY DRIVE NE
ATLANTA GA
30312
US

IV. Provider business mailing address

1190 W DRUID HILL DR NE #T-75
ATLANTA GA
30329
US

V. Phone/Fax

Practice location:
  • Phone: 404-265-4000
  • Fax:
Mailing address:
  • Phone: 404-634-9196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number40927
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: