Provider Demographics
NPI:1679557649
Name:CARKNER, LISA G (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:CARKNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:G
Other - Last Name:UMPHREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2501 CITICO AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1127
Mailing Address - Country:US
Mailing Address - Phone:423-697-2000
Mailing Address - Fax:423-697-2118
Practice Address - Street 1:2501 CITICO AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1127
Practice Address - Country:US
Practice Address - Phone:423-697-2000
Practice Address - Fax:423-697-2118
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34571207R00000X
TN45604207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1519904Medicaid
TN103I061762Medicare PIN