Provider Demographics
NPI:1780188359
Name:CALHOUN, LISA (CPNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 DONALDSON DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1713
Mailing Address - Country:US
Mailing Address - Phone:248-943-5055
Mailing Address - Fax:
Practice Address - Street 1:1605 COLLINS RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4309
Practice Address - Country:US
Practice Address - Phone:770-427-0183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN312751363L00000X, 363L00000X
MARN2342131363L00000X
MI4704302951363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner