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NPI Code Detail

MEDICARE: LIBERTY WELLNESS SERVICES

MEDICARE: LIBERTY WELLNESS SERVICES
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
1207R00000XInternal Medicine Physician40971NC

General Provider Information

NPI Number : 1639606601
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIBERTY WELLNESS SERVICES
Provider Business Mailing Address
First Line : 3941 HOLCOMB BRIDGE RD STE 100
Second Line :
City : NORCROSS
State : GA
Zip : 30092-2292
Country : US
Telephone Number : 470-273-7109
Fax Number :
Provider Business Practice Location Address
First Line : 8601 SIX FORKS RD STE 400
Second Line :
City : RALEIGH
State : NC
Zip : 27615-2965
Country : US
Telephone Number : 470-273-7109
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DANNY LIPTON
Credential :
Telephone Number : 917-855-8336
Provider Enumeration Date : 05/22/2017
Last Update Date : 11/06/2017

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Directions to “LIBERTY WELLNESS SERVICES ” Practice Location

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