Healthcare Provider Details

I. General information

NPI: 1225292733
Provider Name (Legal Business Name): ALEXANDER LIAUGMINAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LACY ST NW SUITE 150
MARIETTA GA
30060-1271
US

IV. Provider business mailing address

100 LACY ST NW SUITE 150
MARIETTA GA
30060-1271
US

V. Phone/Fax

Practice location:
  • Phone: 770-793-7635
  • Fax: 770-793-7645
Mailing address:
  • Phone: 770-793-7635
  • Fax: 770-793-7645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number68236
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: