Healthcare Provider Details

I. General information

NPI: 1699018564
Provider Name (Legal Business Name): LISHA S HO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISHA SHENG

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 PEACHTREE DUNWOODY RD
ATLANTA GA
30342-1764
US

IV. Provider business mailing address

5665 PEACHTREE DUNWOODY RD
ATLANTA GA
30342-1764
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-2656
  • Fax:
Mailing address:
  • Phone: 404-778-3307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA08207
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number008439
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: