Healthcare Provider Details

I. General information

NPI: 1780731729
Provider Name (Legal Business Name): LISA M HARRELL-BOYD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA H BOYD APRN, ACNP

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PRINCE AVE
ATHENS GA
30606-2797
US

IV. Provider business mailing address

550 PEACHTREE ST NE DAVIS-FISCHER BUILDING, OFFICE 3245A
ATLANTA GA
30308-2208
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-5076
  • Fax:
Mailing address:
  • Phone: 404-686-7858
  • Fax: 404-686-7841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN164156
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberRN164156
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: