Healthcare Provider Details

I. General information

NPI: 1750569729
Provider Name (Legal Business Name): LISA H PIPKIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA H PIPKIN APRN

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2849B HENDERSON MILL RD
ATLANTA GA
30341-5772
US

IV. Provider business mailing address

2849B HENDERSON MILL RD
ATLANTA GA
30341-5772
US

V. Phone/Fax

Practice location:
  • Phone: 770-939-1288
  • Fax: 770-212-2203
Mailing address:
  • Phone: 770-939-1288
  • Fax: 770-212-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number135264
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: