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NPI Code Detail

MEDICARE: MS. LISA M FOREMAN NP-C

MEDICARE: MS. LISA M FOREMAN NP-C
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerRN154091GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00164422OTHERGARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RN154091OTHERGARN LICENSE

General Provider Information

NPI Number : 1174510036
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA M FOREMAN NP-C
Provider Business Mailing Address
First Line : 9900 MEDLOCK BRIDGE RD
Second Line :
City : DULUTH
State : GA
Zip : 30097-2017
Country : US
Telephone Number : 770-497-0699
Fax Number : 770-497-0388
Provider Business Practice Location Address
First Line : 9900 MEDLOCK BRIDGE RD
Second Line :
City : DULUTH
State : GA
Zip : 30097-2017
Country : US
Telephone Number : 770-497-0699
Fax Number : 770-497-0388
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2005
Last Update Date : 09/03/2008

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