Healthcare Provider Details

I. General information

NPI: 1225022890
Provider Name (Legal Business Name): LISA A SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 E 3RD ST STE 300
CHATTANOOGA TN
37403-2136
US

IV. Provider business mailing address

979 E 3RD ST STE 300
CHATTANOOGA TN
37403-2136
US

V. Phone/Fax

Practice location:
  • Phone: 423-267-0466
  • Fax: 423-757-0775
Mailing address:
  • Phone: 423-267-0466
  • Fax: 423-757-0775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD34792
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD34792
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: