Provider Demographics
NPI:1093719072
Name:TANGHAL, LIZA (PA C)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:TANGHAL
Suffix:
Gender:F
Credentials:PA C
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1700 TREE LANE RD
Mailing Address - Street 2:STE 320
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2211
Mailing Address - Country:US
Mailing Address - Phone:770-985-6233
Mailing Address - Fax:770-985-6864
Practice Address - Street 1:1700 TREE LANE RD
Practice Address - Street 2:STE 320
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2211
Practice Address - Country:US
Practice Address - Phone:770-985-6233
Practice Address - Fax:770-985-6864
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2016-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA003108363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ24990Medicare UPIN
GA702975947AMedicaid
GAQ24990Medicare UPIN