Provider Demographics
NPI:1225049109
Name:REED, LISA A (PNP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:REED
Suffix:
Gender:F
Credentials:PNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 PROFESSIONAL CT SE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-7020
Mailing Address - Country:US
Mailing Address - Phone:770-546-5578
Mailing Address - Fax:806-771-0305
Practice Address - Street 1:204 PROFESSIONAL CT SE
Practice Address - Street 2:STE. 400
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-7020
Practice Address - Country:US
Practice Address - Phone:706-625-5900
Practice Address - Fax:678-721-4675
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149133 NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA203000015BMedicaid
GA20030098OtherPEDIATRIC CERTIFICATION