Individual
LISA D PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1436 BROADRICK DR, SUITE B, DALTON, GA 30720-3009
(706) 226-3434
(706) 226-4820
Mailing address
1436 BROADRICK DR, SUITE B, DALTON, GA 30720-3009
(706) 226-3434
(706) 226-4820
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APN16722
TN
363L00000X
Nurse Practitioner
Primary
RN247137
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003164332A
—
GA
01
—
03279387
AMERIGROUP
GA
Enumeration date
08/29/2012
Last updated
01/25/2024
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