Provider Demographics
NPI:1265656169
Name:ZAMMIT, LISA FISHER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:FISHER
Last Name:ZAMMIT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 RUSSELL PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7690
Mailing Address - Country:US
Mailing Address - Phone:487-225-9860
Mailing Address - Fax:
Practice Address - Street 1:607 RUSSELL PKWY STE A
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7690
Practice Address - Country:US
Practice Address - Phone:487-225-9860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003468363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP03719Medicare UPIN