MEDICARE: LILBURN ACUPUNCTURE LLC

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	261QH0100X	Health Service Clinic/Center	000344	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	049305387	OTHER	GA	DRIVE LISCENCE

General Provider Information

NPI Number	:	1275041287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILBURN ACUPUNCTURE LLC

Provider Business Mailing Address
First Line	:	4705 LAWRENCEVILLE HWY NW STE B
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-3667
Country	:	US
Telephone Number	:	678-779-6007
Fax Number	:

Provider Business Practice Location Address
First Line	:	4705 LAWRENCEVILLE HWY NW STE B
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-3667
Country	:	US
Telephone Number	:	678-779-6007
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. YIMING LIN
Credential	:	ACUPUNCTURIST
Telephone Number	:	678-779-6007

Provider Enumeration Date	:	01/12/2018
Last Update Date	:	01/12/2018

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