Gentry, Lisa Lovern

Gentry, Lisa Lovern is an individual health care provider with primary practice located at 545 Old Norcross Rd Suite 100, Lawrenceville GA 30046-3389. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Gentry, Lisa Lovern can be contacted via phone (678) 377-2833.

Contact Information

Primary practice address
545 Old Norcross Rd Suite 100 Lawrenceville GA 30046-3389
Phone: (678) 377-2833
Fax: (678) 377-2882
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X SLP003963 Georgia

Profile Details

NPI number 1255407524
LBN Legal business name Gentry, Lisa Lovern
Credentials M.ED.,CCC-SLP
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 28th, 2006
Last updated Aug 17th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255407524 NPPES
Georgia Other 52661318-002 BLUE CROSS BLUE SHIELD
Georgia MEDICAID 000745269A BLUE CROSS BLUE SHIELD
Georgia MEDICAID 10035695 BLUE CROSS BLUE SHIELD
Georgia MEDICAID 305502 BLUE CROSS BLUE SHIELD

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