Provider Demographics
NPI:1144719485
Name:CAIAFA, LISA MAGNANT (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MAGNANT
Last Name:CAIAFA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 HIDDEN SPRINGS WALK SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-4250
Mailing Address - Country:US
Mailing Address - Phone:678-373-9706
Mailing Address - Fax:
Practice Address - Street 1:745 MEMORIAL DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316
Practice Address - Country:US
Practice Address - Phone:404-616-3815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN229307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN229307OtherLICENSEE