MEDICARE: TERRA LOMBER

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	363A00000X	Physician Assistant		TN

General Provider Information

NPI Number	:	1457943888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRA LOMBER

Provider Business Mailing Address
First Line	:	321 BILLINGSLY CT STE 5
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-6445
Country	:	US
Telephone Number	:	615-678-7839
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 BILLINGSLY CT STE 5
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-6445
Country	:	US
Telephone Number	:	615-678-7839
Fax Number	:

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

Provider Enumeration Date	:	02/08/2021
Last Update Date	:	11/03/2021

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Directions to “ TERRA LOMBER ” Practice Location

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