Healthcare Provider Details

I. General information

NPI: 1073556254
Provider Name (Legal Business Name): LISA M. DIFRANCESCO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HOWELL MILL RD NW SUITE 400
ATLANTA GA
30318-0919
US

IV. Provider business mailing address

1800 HOWELL MILL RD NW SUITE 400
ATLANTA GA
30318-0919
US

V. Phone/Fax

Practice location:
  • Phone: 404-377-3474
  • Fax: 404-377-0433
Mailing address:
  • Phone: 404-377-3474
  • Fax: 404-377-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number336122417
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number051130
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: