MEDICARE: GEORGIA PLASTIC SURGERY

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	208200000X	Plastic Surgery Physician	032233	GA

General Provider Information

NPI Number	:	1588934046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA PLASTIC SURGERY

Provider Business Mailing Address
First Line	:	1 GLENLAKE PKWY NE
Second Line	:	SUITE 950
City	:	ATLANTA
State	:	GA
Zip	:	30328-3448
Country	:	US
Telephone Number	:	770-730-8222
Fax Number	:	678-527-1281

Provider Business Practice Location Address
First Line	:	1 GLENLAKE PKWY NE
Second Line	:	SUITE 950
City	:	ATLANTA
State	:	GA
Zip	:	30328-3448
Country	:	US
Telephone Number	:	770-730-8222
Fax Number	:	678-527-1281

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHELDON MICHAEL LINCENBERG
Credential	:	M.D.
Telephone Number	:	770-730-8222

Provider Enumeration Date	:	12/30/2011
Last Update Date	:	12/30/2011

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