Provider Demographics
NPI:1255623575
Name:MASSEY, LIZA NICOLE GILFORD (CPNP)
Entity type:Individual
Prefix:
First Name:LIZA
Middle Name:NICOLE GILFORD
Last Name:MASSEY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 TULLIE RD NE FL 1
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2309
Mailing Address - Country:US
Mailing Address - Phone:404-785-5437
Mailing Address - Fax:404-785-9111
Practice Address - Street 1:1400 TULLIE RD NE FL 1
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2309
Practice Address - Country:US
Practice Address - Phone:404-785-5437
Practice Address - Fax:404-785-9111
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN133970363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner