MEDICARE: LISA E DAVIS

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	104100000X	Social Worker	LSW0000000508	TN
2	1041C0700X	Clinical Social Worker	0508	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4045434	OTHER	TN	B.C.B.S.T.N.
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000146732	OTHER	TN	B.C.B.S.T. NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457413932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA E DAVIS

Provider Business Mailing Address
First Line	:	111 CENTER PARK DR STE 1300
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-2124
Country	:	US
Telephone Number	:	865-898-6877
Fax Number	:	865-691-7364

Provider Business Practice Location Address
First Line	:	111 CENTER PARK DR STE 1300
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-2124
Country	:	US
Telephone Number	:	865-898-6877
Fax Number	:	865-691-7364

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	06/28/2026

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Directions to “ LISA E DAVIS ” Practice Location

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