MEDICARE: DR. LISA LILLICH CULPEPPER MD

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
1	207Q00000X	Family Medicine Physician	046070	GA

General Provider Information

NPI Number	:	1316951999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA LILLICH CULPEPPER MD

Provider Business Mailing Address
First Line	:	11459 JOHNS CREEK PKWY
Second Line	:	SUITE 250
City	:	JOHNS CREEK
State	:	GA
Zip	:	30097-3515
Country	:	US
Telephone Number	:	770-497-1555
Fax Number	:	770-497-9998

Provider Business Practice Location Address
First Line	:	11459 JOHNS CREEK PKWY
Second Line	:	SUITE 250
City	:	JOHNS CREEK
State	:	GA
Zip	:	30097-3515
Country	:	US
Telephone Number	:	770-497-1555
Fax Number	:	770-497-9998

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/05/2023

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