MEDICARE: LISA HARESH JAMBUSARIA M.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	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	MD0000049585	TN

General Provider Information

NPI Number	:	1497982003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA HARESH JAMBUSARIA M.D.

Provider Business Mailing Address
First Line	:	300 20TH AVE N STE 403
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-5180
Country	:	US
Telephone Number	:	615-284-4086
Fax Number	:	615-284-7501

Provider Business Practice Location Address
First Line	:	2011 MURPHY AVE STE 601
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2220
Country	:	US
Telephone Number	:	615-284-2988
Fax Number	:	615-284-2995

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

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	04/08/2021

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