MEDICARE: DR. DOUGLAS A. LIENING 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	207Y00000X	Otolaryngology Physician	MD39461	TN
2	207YX0602X	Otolaryngic Allergy Physician	MD39461	TN
3	207YX0901X	Otology & Neurotology Physician	MD39461	TN

General Provider Information

NPI Number	:	1972568798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS A. LIENING M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 669
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-4905
Country	:	US
Telephone Number	:	423-267-6738
Fax Number	:	423-209-9106

Provider Business Practice Location Address
First Line	:	1724 HAMILL ROAD
Second Line	:	STE 102, OASIS PARK BUILDING I
City	:	HIXSON
State	:	TN
Zip	:	37343-4905
Country	:	US
Telephone Number	:	423-267-6738
Fax Number	:	423-209-9106

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	12/16/2009

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Directions to “ DR. DOUGLAS A. LIENING M.D.” Practice Location

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