Provider Demographics
NPI:1912555061
Name:MAY, LISA RADFORD
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RADFORD
Last Name:MAY
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 1:1808 TITUS MEWBORN RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-8416
Mailing Address - Country:US
Mailing Address - Phone:252-939-6690
Mailing Address - Fax:
Practice Address - Street 1:1808 TITUS MEWBORN RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:NC
Practice Address - Zip Code:28551-8416
Practice Address - Country:US
Practice Address - Phone:252-939-6690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-02
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider