Provider Demographics
NPI:1306931407
Name:ROTZ, LISA (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ROTZ
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 1:1357 THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4622
Mailing Address - Country:US
Mailing Address - Phone:404-284-1984
Mailing Address - Fax:
Practice Address - Street 1:1600 CLIFTON RD MS C-18
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30333
Practice Address - Country:US
Practice Address - Phone:404-639-0385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043760207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease