Winston Liburd
Individual provider Active NPI Prosthetics Case Management · Lawrenceville, GA
NPI 1477907962 · NPPES record last updated Apr 20, 2016
Key facts
- NPI
- 1477907962
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Prosthetics Case Management 1744P3200X
- License
- CO112118 (CO)
- Practice address
- 840 Georgian Hills Dr
Lawrenceville, GA 30045-8697 - Phone
- (404) 750-2378
- NPI assigned
- Apr 20, 2016
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CO112118 | CO | MD | Prosthetics Case Management |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetics Case Management | 1744P3200X | CO112118 | CO | Yes |
Addresses
Primary practice location
840 Georgian Hills Dr
Lawrenceville, GA 30045-8697
Mailing address
840 Georgian Hills Dr
Lawrenceville, GA 30045-8697
Phone (404) 750-2378
NPI Registry JSON
{
"created_epoch": "1461110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461110400000",
"number": "1477907962",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "840 GEORGIAN HILLS DR",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300458697",
"telephone_number": "404-750-2378"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "840 GEORGIAN HILLS DR",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300458697",
"telephone_number": "404-750-2378"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIBURD",
"first_name": "WINSTON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-04-20",
"last_updated": "2016-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "1744P3200X",
"taxonomy_group": "",
"desc": "Specialist, Prosthetics Case Management",
"state": "CO",
"license": "CO112118",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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All providers in Lawrenceville, GA · Prosthetics Case Management in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.