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General NPI Number Information
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NPI Number | 1083165294
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Entity Type | Organization
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Legal Business Name | LILBURN MEDICAL CENTER PC
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Dates
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Enumeration Date | 10/23/2016
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 4705 LAWRENCEVILLE HWY NW
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City | LILBURN
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State | GA
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Zip | 30047-3667
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Country | US
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Telephone | 770-880-5788
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Fax | 404-481-2062
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Provider Business Mailing Address
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Address Line | 4705 LAWRENCEVILLE HWY NW SUITE B
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City | LILBURN
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State | GA
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Zip | 30047-3667
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Country | US
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Telephone | 770-880-5788
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Fax | 404-481-2062
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Authorized Official
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Title or Position | OWENER
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Name | MINSHENG WANG
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Credential | MD
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Telephone | 770-880-5788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 15063657
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License Number State | GA
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