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General NPI Number Information
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NPI Number | 1013314723
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Entity Type | Individual
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Provider Name | LISA THOMAS RD
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Gender | Female
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 3322 W END AVE 11TH FLOOR
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City | NASHVILLE
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State | TN
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Zip | 37203-1031
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Country | US
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Telephone | 615-515-9880
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Fax | 615-515-9891
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Provider Business Mailing Address
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Address Line | 1100 BROAD AVE SUITE 600
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City | GULFPORT
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State | MS
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Zip | 39501
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Country | US
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Telephone | 228-284-1634
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | D0668
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License Number State | MS
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