Provider Demographics
NPI:1013236249
Name:SMITH, LISA ANYAN (PH D)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANYAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 MASON MILL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4074
Mailing Address - Country:US
Mailing Address - Phone:404-215-0107
Mailing Address - Fax:404-321-4887
Practice Address - Street 1:1945 MASON MILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4074
Practice Address - Country:US
Practice Address - Phone:404-215-0107
Practice Address - Fax:404-321-4887
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002232103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist