MEDICARE: LISA GORDON WEISS PA-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
1	363AM0700X	Medical Physician Assistant	7489	GA

General Provider Information

NPI Number	:	1730570409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA GORDON WEISS PA-C

Provider Business Mailing Address
First Line	:	3379 PEACHTREE RD NE
Second Line	:	STE 500
City	:	ATLANTA
State	:	GA
Zip	:	30326-1418
Country	:	US
Telephone Number	:	303-355-5484
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 NORTHSIDE CHEROKEE BLVD STE 410
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-8023
Country	:	US
Telephone Number	:	470-242-0730
Fax Number	:	770-755-5890

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

Provider Enumeration Date	:	02/16/2015
Last Update Date	:	12/11/2025

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