Individual
MRS. LISA ANN WIRTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
500 SPRING STREET SE, SUITE 201, GAINESVILLE, GA 30501-3773
(770) 535-2497
(770) 535-2498
Mailing address
500 SPRING STREET SE, SUITE 201, GAINESVILLE, GA 30501-3773
(770) 535-2497
(770) 535-2498
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
041034
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000677795C
—
GA
Enumeration date
02/06/2006
Last updated
04/19/2017
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