MEDICARE: LISA P. FORD AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	0000001261	TN

General Provider Information

NPI Number	:	1215186671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA P. FORD AU.D.

Provider Business Mailing Address
First Line	:	658 TOTTY CV
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-3071
Country	:	US
Telephone Number	:	901-682-1165
Fax Number	:

Provider Business Practice Location Address
First Line	:	1661 INTERNATIONAL DR STE 400
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-1431
Country	:	US
Telephone Number	:	901-682-1165
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	07/06/2023

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