Healthcare Provider Details

I. General information

NPI: 1285024828
Provider Name (Legal Business Name): LISA OAKES MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE MOT 8TH FLOOR
ATLANTA GA
30308-2208
US

IV. Provider business mailing address

2479 PEACHTREE RD NE #1807
ATLANTA GA
30305-4121
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-5402
  • Fax: 404-686-2015
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: