Individual
DR. MARK L LIPHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
105 DOCTORS DRIVE, CARROLLTON, GA 30117
(770) 832-0012
(770) 832-0685
Mailing address
PO BOX 997, CARROLLTON, GA 30112
(770) 832-0012
(770) 832-0685
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19173
GA
207RP1001X
Pulmonary Disease Physician
19173
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000217753A
—
GA
01
—
024977
BLUE SHIELD
—
Enumeration date
06/14/2006
Last updated
11/13/2024
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