Provider Demographics
NPI:1821346859
Name:PERRY, LISA
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:PERRY
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 1:2145 CANDLER RD
Mailing Address - Street 2:SUITE 1331
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-5574
Mailing Address - Country:US
Mailing Address - Phone:216-326-6048
Mailing Address - Fax:
Practice Address - Street 1:2145 CANDLER RD
Practice Address - Street 2:SUITE 1331
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-5574
Practice Address - Country:US
Practice Address - Phone:216-326-6048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide