Giancarlo Licitra, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

15513 Issued in GA

Practice address

201 Dowman Dr NE
Atlanta, GA 30322-1007

Phone

(404) 727-6123

NPI assigned

Sep 1, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1447928783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 DOWMAN DR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 DOWMAN DR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221007",
            "telephone_number": "404-727-6123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICITRA",
        "first_name": "GIANCARLO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-01",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "15513",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Dianne Licht
• Jay Leonard Lichtenfeld, MD
• Jason Barry Lichtenstein, MD
• Bailee Marie Lichter, MD
• Eric Lichtfuss Jr., PAA
• William Joseph Lick, MD
• Marjorie Abigail Licona-Rivera
• Lida Paez, DMD, LLC
• Brooks Smith Lide III, M.D.
• Kevin T. Lie, MD

• Internal Medicine Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.