Provider Demographics
NPI:1194986455
Name:KLEPCZYK, LISA CAROLINE (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CAROLINE
Last Name:KLEPCZYK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 PEACHTREE RD NW
Mailing Address - Street 2:RADIATION ONCOLOGY DEPT
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1281
Mailing Address - Country:US
Mailing Address - Phone:404-605-4227
Mailing Address - Fax:770-916-3343
Practice Address - Street 1:1968 PEACHTREE RD NW
Practice Address - Street 2:RADIATION ONCOLOGY DEPT
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1281
Practice Address - Country:US
Practice Address - Phone:404-605-4227
Practice Address - Fax:770-916-3343
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL297952085R0001X
GA0720122085R0001X
IL0361633372085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0366100001OtherMC NSC
AL102I926603OtherMEDICARE PTAN
GA202I928503OtherMEDICARE PTAN
GA003148167BMedicaid
AL0366100001OtherCIGNA GOVERNMENT SERVICES PTAN
AL511-36409OtherBCBS
AL148843Medicaid
AL102I926603OtherMEDICARE PTAN