Provider Demographics
NPI:1649427592
Name:LIZCANO-PEREZ, JOSE FERNANDO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:FERNANDO
Last Name:LIZCANO-PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1968 PEACHTREE RD NW
Mailing Address - Street 2:BLDG 77, 5TH FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1281
Mailing Address - Country:US
Mailing Address - Phone:404-605-4600
Mailing Address - Fax:404-609-6720
Practice Address - Street 1:1968 PEACHTREE RD NW
Practice Address - Street 2:BLDG 77, 5TH FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1281
Practice Address - Country:US
Practice Address - Phone:404-605-4600
Practice Address - Fax:404-609-6720
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2016-08-22
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Provider Licenses
StateLicense IDTaxonomies
GA066207207RN0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology