Healthcare Provider Details

I. General information

NPI: 1477550895
Provider Name (Legal Business Name): STEPHEN N LIPSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5185 PEACHTREE PKWY STE 350
PEACHTREE CORNERS GA
30092-6545
US

IV. Provider business mailing address

5185 PEACHTREE PKWY STE 350
PEACHTREE CORNERS GA
30092-6545
US

V. Phone/Fax

Practice location:
  • Phone: 770-858-5437
  • Fax: 770-796-0298
Mailing address:
  • Phone: 770-858-5437
  • Fax: 770-796-0298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number048263
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number42863
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: