Provider Demographics
NPI:1245362367
Name:BELL, LISA A (CRNA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:BELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:CHESSHIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:12 RIDGEFIELD DR SE
Mailing Address - Street 2:
Mailing Address - City:SILVER CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30173-2345
Mailing Address - Country:US
Mailing Address - Phone:678-637-0840
Mailing Address - Fax:
Practice Address - Street 1:12 RIDGEFIELD DR SE
Practice Address - Street 2:
Practice Address - City:SILVER CREEK
Practice Address - State:GA
Practice Address - Zip Code:30173-2345
Practice Address - Country:US
Practice Address - Phone:678-637-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2012-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN156608367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA951694694AMedicaid
GAGRP180OtherMEDICARE GROUP NUMBER
GA951694694AMedicaid
GAGRP180OtherMEDICARE GROUP NUMBER