Healthcare Provider Details

I. General information

NPI: 1316455231
Provider Name (Legal Business Name): LISA ROBERTSON, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 15TH ST
AUGUSTA GA
30901-2608
US

IV. Provider business mailing address

2038 HONORS CIR
GRANITEVILLE SC
29829-4088
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-0188
  • Fax:
Mailing address:
  • Phone: 803-474-5140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20218
License Number StateSC

VIII. Authorized Official

Name: LISA MARIE PARKER
Title or Position: NURSE PRACTITIONER
Credential: MS, APRN
Phone: 803-474-5140