Provider Demographics
NPI:1205355633
Name:ULBRICHT, LISA PRICE (ACNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:PRICE
Last Name:ULBRICHT
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:688 LORIMORE PASS
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-1875
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 WHITCHER ST NE STE 130
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1156
Practice Address - Country:US
Practice Address - Phone:770-426-1629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN206131363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care