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General NPI Number Information
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NPI Number | 1952393878
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Entity Type | Organization
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Legal Business Name | GEORGIA LITHO GROUP LLLP
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 09/14/2007
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Provider Practice Location Address
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Address Line | 750 HAMMOND DR NE BUILDING 18 SUITE 100
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City | ATLANTA
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State | GA
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Zip | 30328-5532
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Country | US
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Telephone | 404-255-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 750 HAMMOND DR NE BUILDING 18 SUITE 100
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City | ATLANTA
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State | GA
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Zip | 30328-5532
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Country | US
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Telephone | 404-255-9300
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Fax | 404-255-9311
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Authorized Official
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Title or Position | VP FOR GENERAL PARTNER
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Name | MRS. TRACY M STOLARSKI
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Credential |
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Telephone | 404-255-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QL0400X
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Taxonomy Name | Lithotripsy Clinic/Center
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License Number |
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License Number State |
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