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1801255161
LISA BLACK
SUWANEE, GA
NPI
1801255161
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
235Z00000X Speech-Language Pathologist,
(Licence: GA 14052341)
Enumeration Date
2016-02-15
Last Update Date
2020-02-10
Business Address
LISA BLACK
5400 LAUREL SPRINGS PKWY BLDG 400 #404
SUWANEE, GA 30024-6056
Phone number: 678-473-9954
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Mailing Address
LISA BLACK
2355 ASHTON DR
ROSWELL, GA 30076-4233
Phone number: 858-472-3022
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