| Doctor Name: | LISA MARTIN |
| NPI Number: | 1275944381 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 1-054482 |
| Business Practice Address: | 966 Claxton Ave N Elba, AL - 363231541 |
| Business Phone Number: | 3348970650 |
| Business Fax Number: | |
| Mailing Address: | 966 Claxton Ave N, ELBA |
| State: | AL |
| Postal Code: | 363231541 |
| Phone Number: | 3348970650 |
| Fax Number: | |
| NPI Enumeration Date: | 05/12/2014 |
| NPI Last Update Date: | 05/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | 1-054482 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |