Provider Demographics
NPI:1942452065
Name:LAMAR, LISA G (CERTIFIEDHHHIDE)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:LAMAR
Suffix:
Gender:F
Credentials:CERTIFIEDHHHIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 MARTIN LUTHER KING JR. BLOUVARD
Mailing Address - Street 2:
Mailing Address - City:TENNILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31089
Mailing Address - Country:US
Mailing Address - Phone:478-553-9412
Mailing Address - Fax:
Practice Address - Street 1:517 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TENNILLE
Practice Address - State:GA
Practice Address - Zip Code:31089-1440
Practice Address - Country:US
Practice Address - Phone:478-553-9412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN000016927374U00000X
GACN0000016927374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide