Provider Demographics
NPI:1306397336
Name:HONG, LISA (C-AA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HONG
Suffix:
Gender:F
Credentials:C-AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 551420
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-1420
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:855-851-4405
Practice Address - Street 1:400 MALL BLVD
Practice Address - Street 2:SUITE T
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4861
Practice Address - Country:US
Practice Address - Phone:912-355-7214
Practice Address - Fax:912-351-7121
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA8151367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant