Provider Demographics
NPI:1528478344
Name:LISTER, JANNA NOVOTNY (NP-C)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:NOVOTNY
Last Name:LISTER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:DENEEN
Other - Last Name:NOVOTNY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703
Mailing Address - Country:US
Mailing Address - Phone:706-602-7800
Mailing Address - Fax:
Practice Address - Street 1:21 COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:ADAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30103-2009
Practice Address - Country:US
Practice Address - Phone:770-773-9201
Practice Address - Fax:770-773-9219
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN173974363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner