Provider Demographics
NPI:1295911006
Name:MCLEOD, LISA (DO)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 RIVERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5256
Mailing Address - Country:US
Mailing Address - Phone:770-720-7733
Mailing Address - Fax:
Practice Address - Street 1:227 RIVERSTONE DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5256
Practice Address - Country:US
Practice Address - Phone:770-720-7733
Practice Address - Fax:770-720-7557
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA87888207V00000X
172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology