Provider Demographics
NPI:1316951999
Name:CULPEPPER, LISA LILLICH (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:LILLICH
Last Name:CULPEPPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:LILLICH
Other - Last Name:CRISP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11459 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-3515
Mailing Address - Country:US
Mailing Address - Phone:770-497-1555
Mailing Address - Fax:770-497-9998
Practice Address - Street 1:11459 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-3515
Practice Address - Country:US
Practice Address - Phone:770-497-1555
Practice Address - Fax:770-497-9998
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H42336Medicare UPIN
GA08BBVPDMedicare ID - Type Unspecified