Provider Demographics
NPI:1871831354
Name:TURNER, LISA KAY
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:TURNER
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 1:2124 OWLS WAY
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-8413
Mailing Address - Country:US
Mailing Address - Phone:404-514-1468
Mailing Address - Fax:
Practice Address - Street 1:301 BRADLEY ST
Practice Address - Street 2:SUITE 207A
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3238
Practice Address - Country:US
Practice Address - Phone:770-834-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT007292225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist