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1891939617
LISA DIANE BIRD
LAWRENCEVILLE, GA
NPI
1891939617
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
171W00000X Contractor
(Licence: GA MT001319)
Enumeration Date
2009-04-23
Last Update Date
2009-04-23
Business Address
-- LISA DIANE BIRD LMT
271A S CULVER ST
LAWRENCEVILLE, GA 30045-4805
Phone number: 770-366-9438
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Mailing Address
-- LISA DIANE BIRD LMT
1100 INDIAN TRAIL RD APT 2022
NORCROSS, GA 30093-4598
Phone number: 678-595-4624
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