Provider Demographics
NPI:1548242902
Name:STATON, LISA J (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:J
Last Name:STATON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:REGINA
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:975 E 3RD ST
Mailing Address - Street 2:BOX 94
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2103
Mailing Address - Country:US
Mailing Address - Phone:423-778-2998
Mailing Address - Fax:423-778-4452
Practice Address - Street 1:975 E 3RD ST
Practice Address - Street 2:BOX 94
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2103
Practice Address - Country:US
Practice Address - Phone:423-778-2998
Practice Address - Fax:423-778-4452
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC791132KMedicaid
NC1132KOtherBCBS NC
NC10064539OtherRAILROAD MEDICARE
NC10064539OtherRAILROAD MEDICARE
NC2255514DMedicare ID - Type Unspecified