Provider Demographics
NPI:1194223727
Name:DAVIS, LISA DUNCAN (MS RD LDN CNSC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DUNCAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS RD LDN CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 HARR TOWN RD
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-3830
Mailing Address - Country:US
Mailing Address - Phone:423-863-4735
Mailing Address - Fax:
Practice Address - Street 1:217 HARR TOWN RD
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617-3830
Practice Address - Country:US
Practice Address - Phone:423-863-4735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000001530133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered