Healthcare Provider Details

I. General information

NPI: 1144710567
Provider Name (Legal Business Name): LISA CATHY-ANN AKOSA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CIFTON ROAD NE
ATLANTA GA
30322
US

IV. Provider business mailing address

1700 MEDICAL WAY
SNELLVILLE GA
30078-2195
US

V. Phone/Fax

Practice location:
  • Phone: 443-798-1588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN171480
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: