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General NPI Number Information
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NPI Number | 1033359997
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Entity Type | Organization
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Legal Business Name | LISA A. WIRTH, MD LLC
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 500 SPRING ST SE SUITE 201
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City | GAINESVILLE
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State | GA
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Zip | 30501-3773
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Country | US
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Telephone | 770-535-2497
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Fax | 770-535-2498
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Provider Business Mailing Address
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Address Line | 500 SPRING ST SE SUITE 201
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City | GAINESVILLE
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State | GA
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Zip | 30501-3773
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Country | US
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Telephone | 770-535-2497
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Fax | 770-535-2498
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | MRS. LISA ANN WIRTH
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Credential | MD
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Telephone | 770-535-2497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | GA
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