Provider Demographics
NPI:1790409621
Name:LIMORAN, MA LIZA ACASO
Entity type:Individual
Prefix:
First Name:MA LIZA
Middle Name:ACASO
Last Name:LIMORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-4791
Mailing Address - Country:US
Mailing Address - Phone:770-885-8980
Mailing Address - Fax:
Practice Address - Street 1:5674 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3254
Practice Address - Country:US
Practice Address - Phone:770-322-6161
Practice Address - Fax:770-322-6161
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
GA12366363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant