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NPI Code Detail

MEDICARE: MARZI LISA RADPOUR-WILEY PH.D.

MEDICARE: MARZI LISA RADPOUR-WILEY PH.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
11041C0700XClinical Social WorkerLSW03734TN
2103TC0700XClinical PsychologistP2532TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427046200
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARZI LISA RADPOUR-WILEY PH.D.
Provider Business Mailing Address
First Line : 6401 SHALLOWFORD RD
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-5406
Country : US
Telephone Number : 423-893-6500
Fax Number :
Provider Business Practice Location Address
First Line : 6401 SHALLOWFORD RD
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-5406
Country : US
Telephone Number : 423-893-6500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2005
Last Update Date : 09/14/2023

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