Provider Demographics
NPI:1538326707
Name:MACOY, LISA (NP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:MACOY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4000 SHAKERAG HL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4047
Mailing Address - Country:US
Mailing Address - Phone:770-486-7111
Mailing Address - Fax:770-486-7131
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:2008-05-16
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN134284 NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA668569165FMedicaid