Provider Demographics
NPI:1750864625
Name:LIPPERT, ABIGAIL ELISE
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ELISE
Last Name:LIPPERT
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 1:2240 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-5910
Mailing Address - Country:US
Mailing Address - Phone:678-773-3320
Mailing Address - Fax:
Practice Address - Street 1:330 RIVER RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605
Practice Address - Country:US
Practice Address - Phone:678-773-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer