MEDICARE: DR. ANDREW LOUIS SEIBERT 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	174400000X	Specialist	037366	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4229235	OTHER	GA	MANAGE CARE
2	52451836	OTHER	GA	BLUE CROSS BLUE SHIELD
3	29-06972	OTHER	GA	UNITED HEALTHCARE
4	5208	OTHER	GA	PROMINA
5	5466575003	OTHER	GA	CIGNA PPO
6	5208	OTHER	GA	ONE HEALTH
7	582061514001	OTHER	GA	PRUDENTIAL

General Provider Information

NPI Number	:	1467446559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW LOUIS SEIBERT M.D.

Provider Business Mailing Address
First Line	:	600 PROFESSIONAL DR
Second Line	:	STE 140
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30045-7651
Country	:	US
Telephone Number	:	770-995-7989
Fax Number	:	770-277-2930

Provider Business Practice Location Address
First Line	:	600 PROFESSIONAL DR
Second Line	:	STE 140
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30045-7651
Country	:	US
Telephone Number	:	770-995-7989
Fax Number	:	770-277-2930

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	07/08/2007

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