Provider Demographics
NPI:1932388527
Name:LIEBMAN, PAUL HARVEY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HARVEY
Last Name:LIEBMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:155 MEDICAL WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-4940
Mailing Address - Country:US
Mailing Address - Phone:770-996-6661
Mailing Address - Fax:770-996-6355
Practice Address - Street 1:155 MEDICAL WAY
Practice Address - Street 2:SUITE D
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4940
Practice Address - Country:US
Practice Address - Phone:770-996-6661
Practice Address - Fax:770-996-6355
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA017064207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD30065Medicare UPIN