Individual
LISA DENITA GAMBLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE
Contact information
Practice address
270 HERITAGE WALK, WOODSTOCK, GA 30188-3875
(678) 494-5700
Mailing address
270 HERITAGE WALK, WOODSTOCK, GA 30188-3875
(678) 494-5700
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN063961
GA
Other
Enumeration date
08/26/2022
Last updated
08/26/2022
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