Healthcare Provider Details

I. General information

NPI: 1639161557
Provider Name (Legal Business Name): LITHOTRIPSY MANAGEMENT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 HAMMOND DR NE
ATLANTA GA
30328-5532
US

IV. Provider business mailing address

750 HAMMOND DR NE BLDG 18 STE 100
ATLANTA GA
30328-5532
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-9300
  • Fax:
Mailing address:
  • Phone: 404-255-9300
  • Fax: 404-255-9311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRACY M STOLANSKI
Title or Position: PRESIDENT
Credential:
Phone: 404-255-9300