Individual
LISA MARIE MANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1401 PEACHTREE ST NE STE 105, ATLANTA, GA 30309-3023
(293) 222-3304
Mailing address
1401 PEACHTREE ST NE STE 105, ATLANTA, GA 30309-3023
(293) 222-3304
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11417
GA
363A00000X
Physician Assistant
9111500
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11417
GEORGIA PHYSICIAN ASSISTANT LICENSE NUMBER
GA
01
—
9111500
FLORIDA PHYSICIAN ASSISTANT LICENSE NUMBER
FL
Enumeration date
10/03/2018
Last updated
02/21/2023
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