Provider Demographics
NPI:1881160141
Name:MAUPIN, LIANNE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LIANNE
Middle Name:
Last Name:MAUPIN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:LIANNE
Other - Middle Name:
Other - Last Name:MAUPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIANNE GRICE
Mailing Address - Street 1:4685 DORSETT SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-4921
Mailing Address - Country:US
Mailing Address - Phone:770-852-6300
Mailing Address - Fax:
Practice Address - Street 1:4685 DORSETT SHOALS RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-4921
Practice Address - Country:US
Practice Address - Phone:770-852-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-140968363LP0808X
GAGAA-NP002641363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health