Healthcare Provider Details

I. General information

NPI: 1043558893
Provider Name (Legal Business Name): LISA WASHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 MORRIS ST NW #2
ATLANTA GA
30318-4542
US

IV. Provider business mailing address

2685 MORRIS ST NW #2
ATLANTA GA
30318-4542
US

V. Phone/Fax

Practice location:
  • Phone: 770-896-8740
  • Fax:
Mailing address:
  • Phone: 770-896-8740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number172V0000X
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: