Provider Demographics
NPI:1407819204
Name:MCMATH, LISA M (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:MCMATH
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:222 ARBOR SHORES NORTH
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265
Mailing Address - Country:US
Mailing Address - Phone:770-436-1316
Mailing Address - Fax:
Practice Address - Street 1:4000 SHAKERAG HL
Practice Address - Street 2:SUITE 201
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4047
Practice Address - Country:US
Practice Address - Phone:770-486-7111
Practice Address - Fax:770-486-7131
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA053332174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000860753610AMedicaid