Marianne Lissade, AGNP-C
Individual provider Active NPI Adult Health Nurse Practitioner · Stone Mountain, GA
NPI 1780036152 · NPPES record last updated Jan 22, 2024
Key facts
- NPI
- 1780036152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- RN147281 (GA)
- Practice address
- 1825 Rockbridge Rd Ste 15B
Stone Mountain, GA 30087-3306 - Phone
- (470) 444-3134
- Fax
- (470) 276-4370
- NPI assigned
- Jul 8, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Center for Pan Asian Community Services, Inc.
Practice addresses (Care Compare)
6185 Buford Hwy G
Peachtree Corners, GA 30071-2350
Phone (770) 446-0929
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160729001966 | GA | Practitioner - Nurse Practitioner | 7517250400 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN147281 | GA | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center for Pan Asian Community Services, Inc. | Current |
Accepting new patients | |
| Center for Pan Asian Community Services, Inc. | Current |
Accepting new patients | |
| Qcpi-Villagemd, PC | Past |
Accepting new patients |
Locations
6185 Buford Hwy
Bldg B
Peachtree Corners, GA 30071
Phone (770) 446-0929
6185 Buford Hwy
#G
Peachtree Corners, GA 30071
Phone (770) 368-9700
6185 Buford Hwy
Peachtree Corners, GA 30071
Phone (770) 446-0929
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/BFAGCA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | RN147281 | GA | |
| Adult Health Nurse Practitioner | 363LA2200X | RN147281 | GA | Yes |
Addresses
Primary practice location
1825 Rockbridge Rd Ste 15B
Stone Mountain, GA 30087-3306
Mailing address
PO Box 740015
Atlanta, GA 30374-0015
Phone (312) 733-9730
Other practice location 1
133 W Athens St
Winder, GA 30680-1786
Phone (770) 867-6633
Other providers in Stone Mountain, GA
- Lifeline Medical Center, LLC
- Lifeline Primary Care, Inc
- Ma Liza Acaso Limoran
- Lindsay Fuson Wellness LLC
- Kenyon Lindsey
- Perry Philemon Little Jr.
- Joan Liverpool
- Elise Leona Livesey
- Jamay R Logan
- Joseph Charles Martelle Lorenz
All providers in Stone Mountain, GA · Adult Health Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.