Healthcare Provider Details

I. General information

NPI: 1225307812
Provider Name (Legal Business Name): LISA DONIA POPE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA DONIA TAYLOR RN

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2899 TEJAS TRL SW
ATLANTA GA
30331-2811
US

IV. Provider business mailing address

5288 BROOKSHIRE CT
DOUGLASVILLE GA
30135-5365
US

V. Phone/Fax

Practice location:
  • Phone: 404-530-9332
  • Fax: 877-570-2212
Mailing address:
  • Phone: 404-721-5833
  • Fax: 877-570-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number128450
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: