Individual
DR. JONATHAN LEONARD LISS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7196 N LAKE DR, SUITE A, COLUMBUS, GA 31909-1693
(706) 327-4000
(706) 324-2557
Mailing address
PO BOX 160, FORTSON, GA 31808-0160
(706) 327-4000
(706) 324-2557
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
039850
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00651934B
—
GA
Enumeration date
03/16/2006
Last updated
07/08/2007
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