Most Relevant Information
Provider Data
| NPI Number: | 1003050576 |
| Provider Name: | LISA VIVIENNE POLING NP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | RN067035NP |
Most Important Dates
| Enumeration Date: | 04/28/2009 |
| Last Updated: | 12/12/2016 |
Provider Practice Location
1000 CHASTAIN RD NW
KENNESAW
GA
301445588
Practice Location Phone/Fax
| Phone: | 6787972844 |
| Fax: | 6787972827 |
Provider Mailing Location
1000 CHASTAIN RD NW
KENNESAW
GA
301445588
Provider Mailing Phone/Fax
| Phone: | 6787972844 |
| Fax: | 6787972827 |