Provider Demographics
NPI:1932171683
Name:KIMBROUGH-NORTON, LISA LANE (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LANE
Last Name:KIMBROUGH-NORTON
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 FRIARS HEAD DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7643
Mailing Address - Country:US
Mailing Address - Phone:770-831-8696
Mailing Address - Fax:770-539-9001
Practice Address - Street 1:655 JESSE JEWELL PKWY SE
Practice Address - Street 2:STE. C
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3722
Practice Address - Country:US
Practice Address - Phone:770-539-9001
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0010302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer