Provider Demographics
NPI:1780026864
Name:LISA GERMAIN
Entity Type:Organization
Organization Name:LISA GERMAIN
Other - Org Name:CARESOUTH HEALTH AND WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:706-248-9098
Mailing Address - Street 1:145 RIVER BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6472
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:755 EPPS BRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6987
Practice Address - Country:US
Practice Address - Phone:706-353-7711
Practice Address - Fax:706-353-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4154261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy