MEDICARE: DR. JASON CHUN SANG LAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	060528	GA
2	207LP3000X	Pediatric Anesthesiology Physician	060528	GA
3	208VP0000X	Pain Medicine Physician	060528	GA
4	208VP0014X	Interventional Pain Medicine Physician	060528	GA
5	207L00000X	Anesthesiology Physician	060528	GA

General Provider Information

NPI Number	:	1073559894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON CHUN SANG LAM M.D.

Provider Business Mailing Address
First Line	:	3365 ROBINSON RD NE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-2441
Country	:	US
Telephone Number	:	404-309-3330
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 JESSE HILL JR DR SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303-3050
Country	:	US
Telephone Number	:	404-616-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	05/02/2023

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