NPI 1043330301 · live from the CMS NPI Registry
Lisa Yvonne Bradshaw-Small, APRN, BC
Nurse Practitioner, Family in Stone Mountain, GA. National Provider Identifier 1043330301, active.
NPI record
| NPI | 1043330301 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Family 363LF0000X |
| Practice location | 6269 Greenock Dr, Stone Mountain, GA 30087 |
| Practice phone | 404-819-9665 |
| Enumerated | March 30, 2007 |
| Last updated | April 5, 2012 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse, Psych/Mental Health, Adult | 163WP0809X | RN141141 (GA) |
| Nurse Practitioner, Family primary | 363LF0000X | RN141141 (GA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.