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Individual

WILLIAM JAY LICHTENFELD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
6300 HOSPITAL PKWY, SUITE 400, JOHNS CREEK, GA 30097-1828
(678) 205-4261
(678) 417-7187
Mailing address
900 CIRCLE 75 PKWY SE, SUITE 1700, ATLANTA, GA 30339-3035
(770) 953-6929
(770) 953-6972

Taxonomy

Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
051503
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000949583C
GA
01
P00201018
RAILROAD MEDICARE
GA
Enumeration date
07/28/2005
Last updated
06/03/2014
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