Healthcare Provider Details

I. General information

NPI: 1164752358
Provider Name (Legal Business Name): LARA RABAA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 GARRISON DR
MURFREESBORO TN
37129-2570
US

IV. Provider business mailing address

1272 GARRISON DR
MURFREESBORO TN
37129-2570
US

V. Phone/Fax

Practice location:
  • Phone: 615-867-8020
  • Fax: 615-867-7951
Mailing address:
  • Phone: 615-867-8020
  • Fax: 615-867-7951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number53461
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMS22287
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: