Individual
DR. LISA ORTENZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
880 CRESTMARK DR, SUITE 200, LITHIA SPRINGS, GA 30122-2646
(770) 941-8662
(770) 739-6006
Mailing address
880 CRESTMARK DR, SUITE 200, LITHIA SPRINGS, GA 30122-2646
(770) 941-8662
(770) 739-6006
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
023395
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00405358A
—
GA
01
—
58-1397572
FEDERAL TAX ID#
GA
Enumeration date
09/09/2005
Last updated
08/04/2015
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