Provider Demographics
NPI:1205954021
Name:MCBRYAR, LISA PAIGE (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:PAIGE
Last Name:MCBRYAR
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Gender:F
Credentials:NP
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Mailing Address - Street 1:970 SIDNEY MARCUS BLVD NE
Mailing Address - Street 2:#2201
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5613
Mailing Address - Country:US
Mailing Address - Phone:770-331-0425
Mailing Address - Fax:678-347-2104
Practice Address - Street 1:970 SIDNEY MARCUS BLVD
Practice Address - Street 2:2201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324
Practice Address - Country:US
Practice Address - Phone:770-331-0425
Practice Address - Fax:678-347-2104
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2010-03-01
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Provider Licenses
StateLicense IDTaxonomies
GARN112936363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner