Provider Demographics
NPI:1366552945
Name:ATKINSON, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 MIAMI CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-4158
Mailing Address - Country:US
Mailing Address - Phone:770-957-3811
Mailing Address - Fax:
Practice Address - Street 1:1350 S ZACK HINTON PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3361
Practice Address - Country:US
Practice Address - Phone:770-898-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPTA002084OtherLICENSE #