Provider Demographics
NPI:1598875015
Name:LINCENBERG, SHELDON MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:MICHAEL
Last Name:LINCENBERG
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 1:1 GLENLAKE PKWY NE
Mailing Address - Street 2:SUITE 950
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3448
Mailing Address - Country:US
Mailing Address - Phone:770-730-8222
Mailing Address - Fax:678-527-1281
Practice Address - Street 1:1 GLENLAKE PKWY NE
Practice Address - Street 2:SUITE 950
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3448
Practice Address - Country:US
Practice Address - Phone:770-730-8222
Practice Address - Fax:678-527-1281
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032233174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
24BCBCBMedicare ID - Type Unspecified
B48305Medicare UPIN