Provider Demographics
NPI:1225307812
Name:POPE, LISA DONIA (RN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:DONIA
Last Name:POPE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:DONIA
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5288 BROOKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-5365
Mailing Address - Country:US
Mailing Address - Phone:404-721-5833
Mailing Address - Fax:877-570-2212
Practice Address - Street 1:2899 TEJAS TRL SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2811
Practice Address - Country:US
Practice Address - Phone:404-530-9332
Practice Address - Fax:877-570-2212
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA128450163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse