Provider Demographics
NPI:1851439830
Name:DR.LILY NARUSEVICIUS
Entity Type:Organization
Organization Name:DR.LILY NARUSEVICIUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONTEGO
Authorized Official - Middle Name:B
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-845-1219
Mailing Address - Street 1:4890 ROSWELL RD NE STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2606
Mailing Address - Country:US
Mailing Address - Phone:404-845-1200
Mailing Address - Fax:404-845-1269
Practice Address - Street 1:4890 ROSWELL RD NE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2606
Practice Address - Country:US
Practice Address - Phone:404-845-1200
Practice Address - Fax:404-845-1269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037308305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDVJ2Medicare UPIN
GAF10983Medicare UPIN