Joseph P Liebsack, P.A.-C – Physician Assistant

Key facts

NPI: 1528048196
Entity type: Individual (NPI type 1)
Primary specialty: Physician Assistant 363A00000X
License: 002143 (GA)
Practice address: 758 Old Norcross Rd
Suite 100
Lawrenceville, GA 30046-3385
Phone: (770) 962-4300
Fax: (770) 339-7544
NPI assigned: Jan 19, 2006
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Resurgens, LLC Orthopaedic Surgery Physician · Atlanta, GA · NPI 1386697928

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Physician Assistant

State licenses

License	State	Type	Specialty
002143	GA	MD	Occupational Therapy Assistant

Practice roles

Organization	Specialty	Status	New patients
Resurgens, LLC		Past since Mar 1, 2022	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physician Assistant	363A00000X	002143	GA	Yes

Addresses

Primary practice location

758 Old Norcross Rd
Suite 100
Lawrenceville, GA 30046-3385

Mailing address

758 Old Norcross Rd
Suite 100
Lawrenceville, GA 30046-3385
Phone (770) 962-4300

Other identifiers

Identifier	Type	State	Issuer
100002498D	Medicaid	GA

Other providers in Lawrenceville, GA

All providers in Lawrenceville, GA · Physician Assistant in Georgia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2009. 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.

Verify at the official NPI Registry.