MEDICARE: LAWRENCE LEFKOFF 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	2086S0122X	Plastic and Reconstructive Surgery Physician	027594	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	027594	OTHER	GA	027594

General Provider Information

NPI Number	:	1861511230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE LEFKOFF M.D.

Provider Business Mailing Address
First Line	:	755 MOUNT VERNON HWY STE 520
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4280
Country	:	US
Telephone Number	:	404-705-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 MOUNT VERNON HWY STE 520
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4280
Country	:	US
Telephone Number	:	404-705-8080
Fax Number	:

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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