Provider Demographics
NPI:1295287043
Name:BUSCHLEN, LISA M (PAC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BUSCHLEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 TIFT AVE N STE D
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-3579
Mailing Address - Country:US
Mailing Address - Phone:229-382-5554
Mailing Address - Fax:229-382-0530
Practice Address - Street 1:1805 TIFT AVE N STE D
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3579
Practice Address - Country:US
Practice Address - Phone:229-382-5554
Practice Address - Fax:229-382-0530
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPA1673363AM0700X
GA12209363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical