Active NPI
Luisa A Liendo, M.D
- Anatomic Pathology & Clinical Pathology Physician
- Tucker, GA
National Provider Identifier
1104004019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 36650
- Practice address
- 1777 Montreal Cir
Tucker, GA 30084-6802 - Phone
- (770) 934-9200
- NPI assigned
- Feb 1, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 36650 | GA | Primary |
Addresses
Primary practice location
1777 Montreal Cir
Tucker, GA 30084-6802
Mailing address
6099 Kings Mountain Way
Stone Mountain, GA 30087-1927
Phone (770) 923-5277
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36650 | GA | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201824000000",
"number": "1104004019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6099 KINGS MOUNTAIN WAY",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300871927",
"telephone_number": "770-923-5277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1777 MONTREAL CIR",
"city": "TUCKER",
"state": "GA",
"postal_code": "300846802",
"telephone_number": "770-934-9200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIENDO",
"first_name": "LUISA",
"middle_name": "A",
"credential": "M.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-01",
"last_updated": "2008-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "GA",
"license": "36650",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucker, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.