Healthcare Provider Details

I. General information

NPI: 1619164787
Provider Name (Legal Business Name): LIEFINA A THOMAS CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 HAMMOND DR NE BLDG. 19 STE 300
SANDY SPRINGS GA
30328-5532
US

IV. Provider business mailing address

750 HAMMOND DR NE BLDG. 19 STE 300
SANDY SPRINGS GA
30328-5532
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-0636
  • Fax: 404-257-0338
Mailing address:
  • Phone: 404-257-0636
  • Fax: 404-257-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: