MEDICARE: DR. PAUL HARVEY LIEBMAN 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	207RN0300X	Nephrology Physician	017064	GA

General Provider Information

NPI Number	:	1932388527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL HARVEY LIEBMAN M.D.

Provider Business Mailing Address
First Line	:	155 MEDICAL WAY
Second Line	:	SUITE D
City	:	RIVERDALE
State	:	GA
Zip	:	30274-4940
Country	:	US
Telephone Number	:	770-996-6661
Fax Number	:	770-996-6355

Provider Business Practice Location Address
First Line	:	155 MEDICAL WAY
Second Line	:	SUITE D
City	:	RIVERDALE
State	:	GA
Zip	:	30274-4940
Country	:	US
Telephone Number	:	770-996-6661
Fax Number	:	770-996-6355

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

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	10/30/2007

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