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NPI Code Detail

MEDICARE: LISA MARIE REYES-WALSH FNP-BC, PMHNP-BC

MEDICARE: LISA MARIE REYES-WALSH FNP-BC, PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerNP220575GA
2363LP0808XPsychiatric/Mental Health Nurse PractitionerPMH220575GA

General Provider Information

NPI Number : 1396100111
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MARIE REYES-WALSH FNP-BC, PMHNP-BC
Provider Business Mailing Address
First Line : 6425 POWERS FERRY RD STE 300
Second Line :
City : ATLANTA
State : GA
Zip : 30339-2908
Country : US
Telephone Number : 770-789-1064
Fax Number :
Provider Business Practice Location Address
First Line : 6425 POWERS FERRY RD STE 300
Second Line :
City : ATLANTA
State : GA
Zip : 30339-2908
Country : US
Telephone Number : 770-789-1064
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2015
Last Update Date : 10/14/2025

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