1780005645 NPI number — DR. LISA MARIE CARMICHAEL NEWTON DPT

Table of content: DR. LISA MARIE CARMICHAEL NEWTON DPT (NPI 1780005645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780005645 NPI number — DR. LISA MARIE CARMICHAEL NEWTON DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWTON
Provider First Name:
LISA
Provider Middle Name:
MARIE CARMICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780005645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
88 KIRKWOOD RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30317-1133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-356-1038
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3005 OLD ALABAMA RD
Provider Second Line Business Practice Location Address:
BUILDING E
Provider Business Practice Location Address City Name:
JOHNS CREEK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30022-8594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-552-8822
Provider Business Practice Location Address Fax Number:
770-552-8481
Provider Enumeration Date:
12/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT009798 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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