Provider Demographics
NPI:1083697494
Name:DUHAIME, LISA A (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:DUHAIME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2529
Mailing Address - Country:US
Mailing Address - Phone:706-226-8950
Mailing Address - Fax:706-272-6836
Practice Address - Street 1:1200 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2529
Practice Address - Country:US
Practice Address - Phone:706-226-8950
Practice Address - Fax:706-272-6836
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA80969207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003208629AMedicaid
GA80969OtherLICENSE
GAFD7891345OtherDEA
FL270106500Medicaid
FL7729582OtherAETNA
FL239459OtherWELLCARE
FL270106500Medicaid