Provider Demographics
NPI:1174510036
Name:FOREMAN, LISA M (NP-C)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9900 MEDLOCK BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2017
Mailing Address - Country:US
Mailing Address - Phone:770-497-0699
Mailing Address - Fax:770-497-0388
Practice Address - Street 1:9900 MEDLOCK BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2017
Practice Address - Country:US
Practice Address - Phone:770-497-0699
Practice Address - Fax:770-497-0388
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN154091363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN154091OtherRN LICENSE
GAP00164422OtherRAILROAD MEDICARE
50BBHWWMedicare ID - Type Unspecified
GAP00164422OtherRAILROAD MEDICARE