Provider Demographics
NPI:1881198976
Name:SAMPSON, LISA RUSH (AUD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:RUSH
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 FIELDSTONE DR STE 106
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-7108
Mailing Address - Country:US
Mailing Address - Phone:478-452-0578
Mailing Address - Fax:478-453-0967
Practice Address - Street 1:111 FIELDSTONE DR STE 106
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7108
Practice Address - Country:US
Practice Address - Phone:478-452-0578
Practice Address - Fax:478-453-0967
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD001486231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner