Provider Demographics
NPI:1568791341
Name:CHRISTIAN, LISA
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:BROOKS
Mailing Address - State:GA
Mailing Address - Zip Code:30205-0222
Mailing Address - Country:US
Mailing Address - Phone:770-716-5678
Mailing Address - Fax:770-716-5665
Practice Address - Street 1:385 N JEFF DAVIS DR
Practice Address - Street 2:SUITE A
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1875
Practice Address - Country:US
Practice Address - Phone:770-716-5678
Practice Address - Fax:770-716-5665
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA719237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist