Provider Demographics
NPI:1013040062
Name:BECKER, LISA MARIE (RT-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BECKER
Suffix:
Gender:F
Credentials:RT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LAKE HEARN DR NE
Mailing Address - Street 2:STE #450
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1523
Mailing Address - Country:US
Mailing Address - Phone:404-252-7339
Mailing Address - Fax:404-257-0337
Practice Address - Street 1:1100 LAKE HEARN DR NE
Practice Address - Street 2:STE #450
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1523
Practice Address - Country:US
Practice Address - Phone:404-252-7339
Practice Address - Fax:404-257-0337
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001668227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified