Healthcare Provider Details

I. General information

NPI: 1407819204
Provider Name (Legal Business Name): LISA M. MCMATH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 HIGHWAY 34 E STE C
NEWNAN GA
30265-2173
US

IV. Provider business mailing address

222 ARBOR SHRS N
NEWNAN GA
30265-4128
US

V. Phone/Fax

Practice location:
  • Phone: 678-953-2623
  • Fax:
Mailing address:
  • Phone: 678-953-2623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number053332
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: