Provider Demographics
NPI:1699790253
Name:GRAHAM, LISA ROCHELLE (RN, BSN, CDE)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ROCHELLE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RN, BSN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 OAK RD UNIT 1541
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-1914
Mailing Address - Country:US
Mailing Address - Phone:404-396-4417
Mailing Address - Fax:
Practice Address - Street 1:279 W CROGAN ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-6914
Practice Address - Country:US
Practice Address - Phone:404-396-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135816133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education