Provider Demographics
NPI:1124096219
Name:LIPMAN, JOHN C (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:LIPMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3670 HIGHLANDS PKWY SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5184
Mailing Address - Country:US
Mailing Address - Phone:770-953-2600
Mailing Address - Fax:770-953-2602
Practice Address - Street 1:3670 HIGHLANDS PKWY SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5184
Practice Address - Country:US
Practice Address - Phone:770-953-2600
Practice Address - Fax:770-953-2602
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2016-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0340122085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000468905QMedicaid
GA30BDLMMedicare ID - Type UnspecifiedJOHN'S MEDICARE NO.
GAE91099Medicare UPIN