Healthcare Provider Details

I. General information

NPI: 1972568798
Provider Name (Legal Business Name): DOUGLAS A. LIENING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 HAMILL ROAD STE 102, OASIS PARK BUILDING I
HIXSON TN
37343-4905
US

IV. Provider business mailing address

P.O. BOX 669
HIXSON TN
37343-4905
US

V. Phone/Fax

Practice location:
  • Phone: 423-267-6738
  • Fax: 423-209-9106
Mailing address:
  • Phone: 423-267-6738
  • Fax: 423-209-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD39461
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberMD39461
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberMD39461
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: