Individual
DR. LISA DAWN MANDEVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
315 WINN WAY, DECATUR, GA 30030-2111
(404) 299-9724
(404) 299-0382
Mailing address
315 WINN WAY, DECATUR, GA 30030-2111
(404) 299-9724
(404) 299-0382
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
046987
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000832851D
—
GA
05
—
000832851E
—
GA
01
—
0700039
UNITED HEALTHCARE
GA
01
—
160046634
RAILROAD MEDICARE
GA
01
—
2264676
AETNA/ USHC
GA
01
—
598968
BLUE CROSS BLUE SHIELD
GA
01
—
7695077
AETNA/US HEALTHCARE
GA
01
—
CN9240
GROUP RAILROAD MEDICARE
GA
Enumeration date
07/07/2006
Last updated
06/30/2020
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