Individual provider Active NPI

Lisa Michelle McKinnon, CPNP

  • Nurse Practitioner
  • Atlanta, GA
National Provider Identifier
1497213045
Registry record updated Nov 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1497213045 Issued in GA
Practice address
2174 N Druid Hills Rd NE
Atlanta, GA 30329-3102
Phone
(404) 785-9344
Fax
(404) 785-3489
NPI assigned
Mar 2, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1497213045 GA Primary
Pediatrics Physician 208000000X RN223686 GA

Addresses

Primary practice location

2174 N Druid Hills Rd NE
Atlanta, GA 30329-3102

Mailing address

2174 N Druid Hills Rd NE
Brookhaven, GA 30329-3102
Phone (404) 784-0242

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191127001078 GA Order and Referring Only - Nurse Practitioner 8820421159

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN223686GAMDPediatrics Physician
1497213045GAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Choa Multispecialty, LLC Pediatrics Past Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762214400000",
    "number": "1497213045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2174 N DRUID HILLS RD NE",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303293102",
            "telephone_number": "404-784-0242",
            "fax_number": "404-785-3489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2174 N DRUID HILLS RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303293102",
            "telephone_number": "404-785-9344",
            "fax_number": "404-785-3489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINNON",
        "first_name": "LISA",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "CPNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-02",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "1497213045",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "RN223686",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.