Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0000015841 | TN |
N | 207Q00000X | Family Doctor | C6492 | AR |
N | 207QA0401X | Family Doctor - Addiction Medicine | MD446896 | PA |
NPI | 1366698755 |
---|---|
Provider Name | Dr. Lisa Fara |
First Address | Signal Mountain, TN 37377-1271 |
Second Address | Chattanooga, TN 37421-6795 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2008 |
Last Update Date | 26/09/2019 |