Healthcare Provider Details

I. General information

NPI: 1760844427
Provider Name (Legal Business Name): ROBERT MICHAEL LIEBMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 WATERS AVE BLDG 400
SAVANNAH GA
31404-6220
US

IV. Provider business mailing address

4700 WATERS AVE BLDG 400
SAVANNAH GA
31404-6220
US

V. Phone/Fax

Practice location:
  • Phone: 912-350-8712
  • Fax: 912-350-8753
Mailing address:
  • Phone: 912-350-8712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number93097
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME149722
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: