MEDICARE: CHRIST-LEE LIZAIRE-GANTHIER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP1600X	Pastoral Counselor
2	171M00000X	Case Manager/Care Coordinator
3	171R00000X	Interpreter
4	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1104613926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRIST-LEE LIZAIRE-GANTHIER

Provider Business Mailing Address
First Line	:	5431 CONFEDERATE CAMP CIR SW
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-4755
Country	:	US
Telephone Number	:	404-931-1797
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 GEES MILL RD NE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-1362
Country	:	US
Telephone Number	:	404-931-1797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2025
Last Update Date	:	06/26/2025

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Directions to “ CHRIST-LEE LIZAIRE-GANTHIER ” Practice Location

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