Provider Demographics
NPI:1427046622
Name:LAYA, LISA (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:LAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:B
Other - Last Name:LAYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5653 FRIST BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2064
Mailing Address - Country:US
Mailing Address - Phone:615-889-7751
Mailing Address - Fax:615-885-6527
Practice Address - Street 1:3515 CENTRAL PIKE
Practice Address - Street 2:STE 105
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2029
Practice Address - Country:US
Practice Address - Phone:615-889-7751
Practice Address - Fax:615-885-6527
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26917207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3823894Medicaid
TN3823894Medicaid
TN3823894Medicare ID - Type Unspecified