MEDICARE: DR. LISA J MAHAN MD

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	207P00000X	Emergency Medicine Physician	35126	TN
2	207R00000X	Internal Medicine Physician	35126	TN

Other Identifiers

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

General Provider Information

NPI Number	:	1508824285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA J MAHAN MD

Provider Business Mailing Address
First Line	:	PO BOX 746725
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6725
Country	:	US
Telephone Number	:	901-401-7150
Fax Number	:	901-347-1285

Provider Business Practice Location Address
First Line	:	3360 N WATKINS ST
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38127-6405
Country	:	US
Telephone Number	:	901-401-7150
Fax Number	:

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	03/31/2026

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