LISA MARIE WALSH (NPI# 1396100111) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396100111 |
| Entity Type | Individual |
| Full Name | LISA MARIE WALSH |
| Credential | FNP-BC, PMHNP-BC |
| Practice Address |
4343 Shallowford Rd Ste B7b Marietta GA 30062 |
| Mailing Address |
4343 Shallowford Rd Ste B7b Marietta GA 30062-5021 |
| Practice Telephone | 6789056880 |
| Practice Fax Number | 6788662358 |
| Mailing Telephone | 6789056880 |
| Mailing Fax Number | 6788662358 |
| Enumeration Date | 2015-12-21 |
| Last Update Date | 2018-08-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
220575 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
220575 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 800 Kennesaw Ave Nw, Suite 120, Marietta, GA 300601051 | 6782137645 | 6787231560 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457867665 | Lisa Christine Walsh | Social Worker | 6439 Glorywhite St, Lakewood, CA 90713-2215 | 2017-12-26 |
| 1497888242 | Lisa Walsh | Chiropractor | 407 N San Mateo Dr, San Mateo, CA 94401-2417 | 2007-03-13 |
| 1477945897 | Lisa Walsh | Occupational Therapist | 675 S Roselle Rd, Schaumburg, IL 60193-3100 | 2015-02-22 |
| 1962783092 | Lisa Dyan Walsh | Psychologist | 6394 College Blvd, Overland Park, KS 66211-1506 | 2011-09-02 |
| 1972644771 | Lisa Walsh | Advanced Practice Midwife | 2 Water St, Central Plaza - Women's Health Care, Haverhill, MA 01830-6229 | 2007-02-12 |
| 1467524793 | Lisa Marie Walsh | Speech-Language Pathologist | 8323 Southwest Freeway, #101, Houston, TX 77074 | 2006-11-14 |
| 1679651061 | Lisa Kathleen Walsh | Psychologist | 233 Fulton St E, Suite 14, Grand Rapids, MI 49503-3200 | 2006-11-01 |
| 1689770547 | Lisa Marie Walsh II | Dietitian, Registered | 5000 W National Ave, Milwaukee, WI 53295-0001 | 2006-09-16 |
| Street Address |
4343 SHALLOWFORD RD STE B7B |
| City | MARIETTA |
| State | GA |
| Zip Code | 30062 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619578051 | Pamela D Kretzmer | Social Worker | 3855 Shallowford Road, Suite 420, Marietta, GA 30062 | 2020-11-03 |
| 1932714680 | Michelle Chambless | Physical Therapist | Team Rehabilitation Ga01, LLC, 1401 Johnson Ferry Road, Suite 340, Marietta, GA 30062 | 2020-09-10 |
| 1700408887 | Life University | Chiropractor | 1323 Roswell Road, Marietta, GA 30062 | 2020-05-12 |
| 1104451160 | Sno Healthcare Group | Clinic/Center | 2424 Roswell Rd Ste 120, Marietta, GA 30062 | 2020-03-10 |
| 1811536212 | Sandy Plains Dental Group, PC | Dentist | 3460 Sandy Plains Rd, Suite 240, Marietta, GA 30062 | 2020-01-02 |
| 1073159034 | Magdala Tulcie Jodesty-jackson | Social Worker | 4343 Shalloword Road, Building H, Suite 4 Lower Level, Marietta, GA 30062 | 2019-11-25 |
| 1598235178 | Matthew Driggers | Counselor | 4343 Shallowford Rd C2, Marietta, GA 30062 | 2018-11-27 |
| 1750895785 | Emily Grace Minday | Counselor | 4343 Shallowford Road Building C, Suite 1 Lower Level, Marietta, GA 30062 | 2017-11-29 |
| 1477072122 | Jason Lee Amos | Speech-Language Pathologist | 3660 Chestnut Ridge Court, Marietta, GA 30062 | 2017-09-13 |
| 1346761376 | Marian Pomaah Opoku-agyeman | Nurse Practitioner | 4661 Andrea Pointe, Marietta, GA 30062 | 2017-06-29 |
| Find all providers in zip 30062 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194358754 | Beatrice Odero | Nurse Practitioner | 3727 Mill Lake Dr, Marietta, GA 30060-6273 | 2020-02-21 |
| 1407402910 | Augusta Williams | Nurse Practitioner | Attn: Augusta Williams, 2131 Kingston Court Suite 108, Marietta, GA 30067-8929 | 2019-08-12 |
| 1134727696 | Julie Nicole Polcyn | Nurse Practitioner | 207d Colegate Dr, Marietta, OH 45750-2363 | 2020-10-15 |
| 1710595988 | Chinwe Okafor | Nurse Practitioner | 1277 Kennestone Cir, Marietta, GA 30066-6029 | 2020-07-14 |
| 1497372080 | Trisha Leigh Bail | Nurse Practitioner | 207d Colegate Dr, Marietta, OH 45750-2363 | 2020-06-29 |
| 1912460601 | Jasmine Young | Nurse Practitioner | 1640 Powers Ferry Rd Se Ste 330, Marietta, GA 30067-5491 | 2019-04-09 |
| 1720543432 | Lacy Marie Workman | Nurse Practitioner | 401 Matthew St, Marietta, OH 45750-1635 | 2019-02-06 |
| 1598240822 | Maima Fortune | Nurse Practitioner | 2540 Windy Hill Rd Se, Marietta, GA 30067-8605 | 2018-10-02 |
| 1538662622 | Lorna Brown | Nurse Practitioner | 1825 County Services Pkwy Sw, Marietta, GA 30008 | 2018-03-14 |
| 1295275949 | Tanya Camiela Dunkley | Nurse Practitioner | 2540 Windy Hill Rd Se, Marietta, GA 30067-8605 | 2017-02-28 |
| Find all providers in MARIETTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.