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General NPI Number Information
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NPI Number | 1467137216
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Entity Type | Individual
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Provider Name | ALEXSIS TRIPP
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Gender | Female
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 3580 MEMORIAL DR
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City | DECATUR
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State | GA
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Zip | 30032-2723
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Country | US
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Telephone | 404-284-0701
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Fax | 404-284-0703
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Provider Business Mailing Address
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Address Line | 7225 CUTTERS CT
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City | LITHONIA
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State | GA
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Zip | 30058-8603
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Country | US
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Telephone | 470-265-5449
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | LDO002705
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License Number State | GA
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