Individual
LISA RENEE MCKENTLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
4425 S COBB DR SE, SUITE G, SMYRNA, GA 30080-6368
(770) 444-9191
(770) 444-9391
Mailing address
3303 HIDDEN TRAIL RD SE, SMYRNA, GA 30082-2442
(404) 520-0526
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIR007854
GA
Other
Enumeration date
07/17/2006
Last updated
07/08/2007
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