NPIMap

Individual provider Active NPI

Craig L Lebish, MD

  • Pediatric Adolescent Medicine Physician
  • Marietta, GA
National Provider Identifier
1679523443
Registry record updated Mar 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
041867 Issued in GA
Practice address
3405 Dallas Hwy SW Ste 300
Marietta, GA 30064-6426
Phone
(770) 425-5331
Fax
(770) 425-0799
NPI assigned
May 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X 041867 GA Primary

Addresses

Primary practice location

3405 Dallas Hwy SW Ste 300
Marietta, GA 30064-6426

Mailing address

3405 Dallas Hwy SW Ste 300
Marietta, GA 30064-6426
Phone (770) 425-5331

Other identifiers 3

IdentifierTypeStateIssuer
000735193BMedicaidGA
000735193CMedicaidGA
000735193DMedicaidGA

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)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
041867GAMDPediatric Adolescent Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cobb Pediatrics, PC Past Accepting new patients
Cobb Pediatrics Adolescent Medicine Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: craig.lebish@gadirect.net

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393804800000",
    "number": "1679523443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3405 DALLAS HWY SW STE 300",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300646426",
            "telephone_number": "770-425-5331",
            "fax_number": "770-425-0799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3405 DALLAS HWY SW STE 300",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300646426",
            "telephone_number": "770-425-5331",
            "fax_number": "770-425-0799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEBISH",
        "first_name": "CRAIG",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2014-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "GA",
            "license": "041867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000735193B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000735193C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000735193D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2014; 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.