Provider Demographics
NPI:1366698755
Name:FARA, LISA (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:FARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3813 WINDTREE DR
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-1271
Mailing Address - Country:US
Mailing Address - Phone:901-619-9001
Mailing Address - Fax:888-563-1169
Practice Address - Street 1:7030 LEE HWY STE 201
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6795
Practice Address - Country:US
Practice Address - Phone:610-207-0900
Practice Address - Fax:888-563-1169
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC6492207Q00000X
PAMD446896207QA0401X
TN0000015841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine