MEDICARE: GINA P LUNDBERG MD

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	207RC0000X	Cardiovascular Disease Physician	032458	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902828924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA P LUNDBERG MD

Provider Business Mailing Address
First Line	:	1838 AMERICAN WAY
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-6611
Country	:	US
Telephone Number	:	770-995-7622
Fax Number	:	770-995-7854

Provider Business Practice Location Address
First Line	:	137 JOHNSON FERRY RD
Second Line	:	SUITE 1200
City	:	MARIETTA
State	:	GA
Zip	:	30068-4945
Country	:	US
Telephone Number	:	678-843-9601
Fax Number	:	678-843-9650

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	03/27/2013

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