Provider Demographics
NPI:1336160233
Name:LIEBSACK, JOSEPH P II (PA-C)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:LIEBSACK
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60969
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31420-0969
Mailing Address - Country:US
Mailing Address - Phone:912-691-5711
Mailing Address - Fax:678-623-3695
Practice Address - Street 1:7001 HODGSON MEMORIAL DR STE 1
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2549
Practice Address - Country:US
Practice Address - Phone:912-298-6646
Practice Address - Fax:912-298-6622
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004192363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
97WCHCLMedicare PIN
GAQ40805Medicare UPIN
GA97WCHCLMedicare ID - Type Unspecified
Q40805Medicare UPIN