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NPI Code Detail

MEDICARE: DR. JOSHUA LIDELLE HARE D.O.

MEDICARE: DR. JOSHUA LIDELLE HARE D.O.
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
1207RA0401XAddiction Medicine (Internal Medicine) Physician071791GA
22083A0300XAddiction Medicine (Preventive Medicine) Physician2663TN
3207LP2900XPain Medicine (Anesthesiology) Physician071791GA
42083A0300XAddiction Medicine (Preventive Medicine) Physician71791GA
5207RA0401XAddiction Medicine (Internal Medicine) Physician2663TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01363024OTHERGARR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1988220OTHERGAWELLCARE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
502045387OTHERGAAMERIGROUP

General Provider Information

NPI Number : 1811121924
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSHUA LIDELLE HARE D.O.
Provider Business Mailing Address
First Line : 2550 BUSINESS PARK DR NE
Second Line :
City : CLEVELAND
State : TN
Zip : 37311-6503
Country : US
Telephone Number : 423-605-8075
Fax Number : 423-472-0454
Provider Business Practice Location Address
First Line : 6141 SHALLOWFORD RD STE 100
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-1663
Country : US
Telephone Number : 423-498-2000
Fax Number : 423-498-2001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2009
Last Update Date : 02/23/2026

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Directions to “ DR. JOSHUA LIDELLE HARE D.O.” Practice Location

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