Individual
DR. JEFFREY A CARLISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3975 LAWRENCEVILLE HWY NW, LILBURN, GA 30047-2817
(770) 923-5000
(770) 717-9325
Mailing address
5901A PEACHTREE DUNWOODY RD NE, STE 500, ATLANTA, GA 30328-5382
(678) 892-2020
(678) 538-1950
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
037164
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00587067A
—
GA
01
—
0479686
AETNA HMO
GA
01
—
05200
COVENTRY PPO
GA
01
—
0891170
UHC
GA
01
—
1078920004
DME
GA
01
—
180025244
RR MEDICARE
GA
01
—
4486398
AETNA
GA
01
—
507240
BCBS
GA
01
—
9856
COVENTRY HMO
GA
Enumeration date
06/30/2005
Last updated
03/08/2021
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