Provider Demographics
NPI:1376521328
Name:HARTMAN, LISA LOU (MSN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:LOU
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:LOU
Other - Last Name:EHLENBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:1210 SPRINGDALE RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2632
Mailing Address - Country:US
Mailing Address - Phone:770-490-0919
Mailing Address - Fax:404-378-0631
Practice Address - Street 1:1210 SPRINGDALE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-2632
Practice Address - Country:US
Practice Address - Phone:770-490-0919
Practice Address - Fax:404-378-0631
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN134198363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000913701ABMedicaid
GA50BBFKQMedicare PIN
GAP36734Medicare UPIN