Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 051503 | GA |
NPI | 1164422572 |
---|---|
Provider Name | William Jay Lichtenfeld |
First Address | Atlanta, GA 30339-3035 |
Second Address | Johns Creek, GA 30097-1828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 03/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000949583C | (05) | GA |
G27871 | (02) | |
P00201018 | RAILROAD MEDICARE (01) | GA |