Healthcare Provider Details

I. General information

NPI: 1477485928
Provider Name (Legal Business Name): LISA STEELE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 FOSSETT RD
CONCORD GA
30206-3213
US

IV. Provider business mailing address

1276 FOSSETT RD
CONCORD GA
30206-3213
US

V. Phone/Fax

Practice location:
  • Phone: 315-945-2891
  • Fax:
Mailing address:
  • Phone: 315-945-2891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18107-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: