Provider Demographics
NPI:1952393878
Name:GEORGIA LITHO GROUP LLLP
Entity Type:Organization
Organization Name:GEORGIA LITHO GROUP LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FOR GENERAL PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:M
Authorized Official - Last Name:STOLARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-255-9300
Mailing Address - Street 1:750 HAMMOND DR NE
Mailing Address - Street 2:BUILDING 18 SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5532
Mailing Address - Country:US
Mailing Address - Phone:404-255-9300
Mailing Address - Fax:404-255-9311
Practice Address - Street 1:750 HAMMOND DR NE
Practice Address - Street 2:BUILDING 18 SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5532
Practice Address - Country:US
Practice Address - Phone:404-255-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy