Provider Demographics
NPI:1376697565
Name:LINTNER, THOMAS BLAISE (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BLAISE
Last Name:LINTNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 CANTON RD NE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8948
Mailing Address - Country:US
Mailing Address - Phone:770-771-5151
Mailing Address - Fax:
Practice Address - Street 1:711 C ANTON RD
Practice Address - Street 2:SUITE 400
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7210
Practice Address - Country:US
Practice Address - Phone:770-771-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0272202086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA203695128OtherEIN
GA203695128OtherEIN
GAF08365Medicare UPIN