Healthcare Provider Details

I. General information

NPI: 1942818422
Provider Name (Legal Business Name): LISA M AREY CSFA, CST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2429 SALEM CT SW
MARIETTA GA
30064-4259
US

IV. Provider business mailing address

2429 SALEM CT SW
MARIETTA GA
30064-4259
US

V. Phone/Fax

Practice location:
  • Phone: 404-387-5060
  • Fax:
Mailing address:
  • Phone: 404-387-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number197090
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: