NPIMap

Organization Active NPI

Lilburn Medical Center PC

  • Primary Care Clinic/Center
  • Lilburn, GA
National Provider Identifier
1083165294
Registry record updated Mar 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
15063657 Issued in GA
Legal business name
LILBURN MEDICAL CENTER PC
Practice address
4705 Lawrenceville Hwy NW
Lilburn, GA 30047-3667
Phone
(770) 880-5788
Fax
(404) 481-2062
NPI assigned
Oct 23, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Minsheng Wang, MDNPI 1679769483
Title
Owener
Phone
(770) 880-5788

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 15063657 GA Primary

Addresses

Primary practice location

4705 Lawrenceville Hwy NW
Lilburn, GA 30047-3667

Mailing address

4705 Lawrenceville Hwy NW
Suite B
Lilburn, GA 30047-3667
Phone (770) 880-5788

National Provider Directory

National Provider Directory

Locations

4705 Lawrenceville Hwy NW
Lilburn, GA 30047
Phone (770) 880-5788

4705 Lawrenceville Hwy NW
Ste B
Lilburn, GA 30047
Phone (678) 691-0839

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490832000000",
    "number": "1083165294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4705 LAWRENCEVILLE HWY NW",
            "address_2": "SUITE B",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473667",
            "telephone_number": "770-880-5788",
            "fax_number": "404-481-2062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 LAWRENCEVILLE HWY NW",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473667",
            "telephone_number": "770-880-5788",
            "fax_number": "404-481-2062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILBURN MEDICAL CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-23",
        "last_updated": "2017-03-30",
        "status": "A",
        "authorized_official_last_name": "WANG",
        "authorized_official_first_name": "MINSHENG",
        "authorized_official_title_or_position": "OWENER",
        "authorized_official_telephone_number": "770-880-5788",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "15063657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lilburn, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.