=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114997269
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA M SEMPLE DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2006
-----------------------------------------------------
Last Update Date | 03/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5354 REYNOLDS ST STE 422
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31405-6011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-354-2634
-----------------------------------------------------
Fax | 912-354-8375
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 836 E 65TH ST STE 22
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31405-4493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-819-7171
-----------------------------------------------------
Fax | 912-691-9287
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 51284
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------