Provider Demographics
NPI:1982622635
Name:RICHARDSON, LISA CAROLYN (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CAROLYN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 BUFORD HWY
Mailing Address - Street 2:MAIL STOP K-55
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3717
Mailing Address - Country:US
Mailing Address - Phone:770-488-4351
Mailing Address - Fax:
Practice Address - Street 1:4770 BUFORD HWY
Practice Address - Street 2:MAIL STOP K-55
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-3717
Practice Address - Country:US
Practice Address - Phone:770-488-4351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044991207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology