Healthcare Provider Details

I. General information

NPI: 1013040062
Provider Name (Legal Business Name): LISA MARIE BECKER R.T.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LAKE HEARN DR NE STE #450
ATLANTA GA
30342-1523
US

IV. Provider business mailing address

1100 LAKE HEARN DR NE STE #450
ATLANTA GA
30342-1523
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-7339
  • Fax: 404-257-0337
Mailing address:
  • Phone: 404-252-7339
  • Fax: 404-257-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number001668
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: