| Lisa A. Wirth, Md Llc | |
|
500 Spring St Se Suite 201 Gainesville GA 30501-3773 | |
| (770) 535-2497 | |
| (770) 535-2498 |
| Full Name | Lisa A. Wirth, Md Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 500 Spring St Se, Gainesville, Georgia |
| Authorized Official Name and Position | Lisa Ann Wirth (DOCTOR/OWNER) |
| Authorized Official Contact | 7705352497 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa A. Wirth, Md Llc 500 Spring St Se Suite 201 Gainesville GA 30501-3773 Ph: (770) 535-2497 | Lisa A. Wirth, Md Llc 500 Spring St Se Suite 201 Gainesville GA 30501-3773 Ph: (770) 535-2497 |
| NPI Number | 1033359997 |
|---|---|
| Provider Enumeration Date | 03/04/2009 |
| Last Update Date | 07/13/2016 |
| Medicare PECOS PAC ID | 6204984578 |
|---|---|
| Medicare Enrollment ID | O20090427000307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033359997 | NPI | - | NPPES |
| 000677795C | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (Georgia) | Primary |
| Provider Name | Lisa A Wirth |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932171758 PECOS PAC ID: 1355230673 Enrollment ID: I20040315000214 |
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