Provider Demographics
NPI:1568026748
Name:LILES, DAVID CAMPBELL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CAMPBELL
Last Name:LILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CAMPBELL
Other - Middle Name:
Other - Last Name:LILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6710 SONYA DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209
Mailing Address - Country:US
Mailing Address - Phone:405-476-4886
Mailing Address - Fax:
Practice Address - Street 1:1161 21ST AVENUE SOUTH
Practice Address - Street 2:T4224 MEDICAL CENTER NORTH
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-2380
Practice Address - Country:US
Practice Address - Phone:615-343-2452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program