Basic Information
Provider Information
NPI: 1154640498
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STARECKI
FirstName: LIZA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 531 ROSELANE ST NW STE 830
Address2:  
City: MARIETTA
State: GA
PostalCode: 300606979
CountryCode: US
TelephoneNumber: 7707940477
FaxNumber:  
Practice Location
Address1: 677 CHURCH ST NE
Address2:  
City: MARIETTA
State: GA
PostalCode: 300601101
CountryCode: US
TelephoneNumber: 7707940477
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/26/2010
LastUpdateDate: 08/27/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207LP2900X076963GAN Allopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
207LP3000X076963GAN Allopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
208VP0000X076963GAN Allopathic & Osteopathic PhysiciansPain MedicinePain Medicine
208VP0014X076963GAN Allopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
207L00000X76963GAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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