| Doctor Name: | MRS. LISA YVONNE BRADSHAW-SMALL |
| NPI Number: | 1043330301 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN, BC |
| License Number: | RN141141 |
| Business Practice Address: | 6269 Greenock Dr Stone Mountain, GA - 300876081 |
| Business Phone Number: | 4048199665 |
| Business Fax Number: | 6788256030 |
| Mailing Address: | 6269 Greenock Dr, STONE MOUNTAIN |
| State: | GA |
| Postal Code: | 300876081 |
| Phone Number: | 4048199665 |
| Fax Number: | 6788256030 |
| NPI Enumeration Date: | 03/30/2007 |
| NPI Last Update Date: | 04/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0809X |
| License Number: | RN141141 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health, Adult |
| Taxonomy Definition: | |