Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 002232 | GA |
Y | 103T00000X | Psychologist | 002232 | GA |
NPI | 1013236249 |
---|---|
Provider Name | Dr. Lisa Anyan Smith |
First Address | Decatur, GA 30033-4074 |
Second Address | Decatur, GA 30033-4074 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2010 |
Last Update Date | 27/05/2010 |