Healthcare Provider Details

I. General information

NPI: 1962665042
Provider Name (Legal Business Name): LILI NELL MORAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LILI NELL BANAN M.D.

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 MCARTHUR ST
MANCHESTER TN
37355-2522
US

IV. Provider business mailing address

1608 MCARTHUR ST
MANCHESTER TN
37355-2522
US

V. Phone/Fax

Practice location:
  • Phone: 931-723-2036
  • Fax:
Mailing address:
  • Phone: 931-723-2036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number62933
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: