DR. LILLIAN KIM IVANSCO (NPI# 1043478605) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043478605 |
| Entity Type | Individual |
| Full Name | DR. LILLIAN KIM IVANSCO |
| Credential | M.D., M.P.H. |
| Practice Address |
20 Glenlake Pkwy Atlanta GA 30328-3473 |
| Mailing Address |
3495 Piedmont Rd Ne Atlanta GA 30305-1717 |
| Practice Telephone | 4043647285 |
| Mailing Telephone | (404) 364-7285 |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2017-07-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
MD17668 | HI | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
04-37114 | KS | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
27713 | NE | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
53370 | CO | Allopathic & Osteopathic Physicians |
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
069869 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NE | 10026277300 | 05 | |
| CO | 79754571 | 05 | |
| NE | 10026277400 | 05 | |
| NE | 10026277500 | 05 | |
| NE | 10026277800 | 05 | |
| IA | 1043478605 | 05 | |
| NE | 10026277600 | 05 | |
| NE | 10026277700 | 05 | |
| WY | 1043478605 | 05 | |
| KS | 201098570A | 05 | |
| UT | 1043478605 | 05 | |
| AZ | 929695 | 05 | |
| MT | 1043478605 | 05 | |
| NE | 10025709000 | 05 | |
| NM | 66229006 | 05 |
| Street Address |
20 GLENLAKE PKWY |
| City | ATLANTA |
| State | GA |
| Zip Code | 30328-3473 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487655528 | Thomas Wilson Phillips | Radiology | 20 Glenlake Pkwy, Radiation Oncology, Atlanta, GA 30328 | 2005-08-10 |
| 1659998177 | Jamie Elizabeth Coates | Pharmacist | 20 Glenlake Pkwy, Atlanta, GA 30328-3431 | 2020-06-30 |
| 1891335014 | Jenna R Van Zelfden | Nurse Practitioner | 20 Glenlake Pkwy, Atlanta, GA 30328-3473 | 2020-01-15 |
| 1346801362 | Chisom Chijioke Odogwu | Physician Assistant | 20 Glenlake Pkwy, Atlanta, GA 30328-3473 | 2019-06-21 |
| 1790269579 | Lauren Erin Holcomb | Physician Assistant | 20 Glenlake Pkwy, Atlanta, GA 30328-3473 | 2018-09-18 |
| 1528592094 | Kurtis Bertram | Podiatrist | 20 Glenlake Pkwy, Atlanta, GA 30328-3473 | 2017-04-12 |
| 1598111536 | Tiffany Casper | Advanced Practice Midwife | 20 Glenlake Pkwy, Atlanta, GA 30328 | 2016-05-09 |
| 1417343120 | Kaiser Foundation Health Plan of Georgia, Inc. | Pharmacy | 20 Glenlake Pkwy, Atlanta, GA 30328-3473 | 2015-04-09 |
| 1538419726 | James Joseph Weigel | Social Worker | 20 Glenlake Pkwy, Behavioral Health, Atlanta, GA 30328 | 2012-09-14 |
| 1053674903 | Yi-jou Tsai | Psychiatry & Neurology | 20 Glenlake Pkwy, Atlanta, GA 30328-3473 | 2012-06-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467910042 | Amber Andrews | Behavior Technician | 750 Hammond Drive Bldg 7 Suite 100, Atlanta, GA 30328 | 2019-03-04 |
| 1215492830 | Ryan William Dubinin | Behavior Technician | 750 Hammond Drive, Building 7, Suite 100, Atlanta, NJ 30328 | 2019-02-07 |
| 1346710142 | Emily Rose Lloyd Swavely | Speech-Language Pathologist | 5825 Glenridge Rd., Building 1, Suite 133, Atlanta, GA 30328 | 2018-12-05 |
| 1063994481 | Mark Edward Brachmanski | Optometrist | 800 Mount Vernon Highway Ne, Suite 130, Atlanta, GA 30328 | 2018-09-01 |
| 1407352578 | Nina Brown | Massage Therapist | 7100 Peachtree Dunwoody Rd Ste 110, Sandy Springs, GA 30328 | 2018-04-05 |
| 1336657741 | Renee Usher Reeves | Assistant Behavior Analyst | 750 Hammond Dr Building 7, Suite 100, Atlanta, GA 30328 | 2018-01-19 |
| 1487168274 | Patricia Nicole Felder | Student in an Organized Health Care Education/Training Program | 270 Carpenter Dr, Ne, Suite # 400, Atlanta, GA 30328 | 2017-12-01 |
| 1447762927 | Ponders Podiatry LLC | Podiatrist | 275 Carpenter Drive Ne, Suite 106, Atlanta, GA 30328 | 2017-10-24 |
| 1770093601 | Syed M Rasheed | Physician Assistant | 5788 Roswell Rd Ste 100, Atlanta, GA 30328 | 2017-10-05 |
| 1437678190 | Jeanette Denise Jones | Counselor | 270 Carpenter Drive, Suite 400, Sandy Springs, GA 30328 | 2017-09-13 |
| Find all providers in zip 30328 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770945016 | Charlotte Chung | Radiology | 1364 Clifton Rd Ne Rm D125a, Atlanta, GA 30322-4509 | 2016-03-25 |
| 1295172351 | Philip Kin-wai Wong | Radiology | 1364 Clifton Rd Ne Ste D125, Atlanta, GA 30322 | 2013-05-30 |
| 1982049292 | Mohamed Yahya Al Sawaf | Radiology | 550 Peachtree St. N.w., Atlanta, GA 30309 | 2013-05-01 |
| 1699015792 | Peter Ju Park | Radiology | 100 Woodruff Cir Ne, Suite 327, Atlanta, GA 30322-0001 | 2013-02-26 |
| 1851657571 | Mircea Mihai Cristescu | Radiology | Emory University 1364 Clifton Rd, Atlanta, GA 30322 | 2012-04-06 |
| 1912273483 | Sagar Bipin Amin | Radiology | 1365 Clifton Rd Ne Dept Of, Atlanta, GA 30322 | 2012-03-28 |
| 1417236241 | Ernst Murphy Ruder | Radiology | 1175 W Garmon Rd Nw, Atlanta, GA 30327-4401 | 2011-08-10 |
| 1124311212 | Colin Michael Segovis | Radiology | Emory University 1364 Clifton Rd Ne, Atlanta, GA 30332 | 2011-05-23 |
| 1518265883 | Barbara Erwin Robertson | Radiology | 11 Riverly Pl Nw, Atlanta, GA 30327-2500 | 2011-03-10 |
| 1881918845 | Margaret Fleming | Radiology | 1365 Clifton Road, Department of Radiology, Suite D-125a, Atlanta, GA 30322 | 2010-03-19 |
| Find all providers in ATLANTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.