Provider Demographics
NPI:1851319065
Name:LILLY, MARI LYNN (MD)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:LYNN
Last Name:LILLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 MOUNTAIN CREEK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-4501
Mailing Address - Country:US
Mailing Address - Phone:423-870-0036
Mailing Address - Fax:423-870-0706
Practice Address - Street 1:901 MOUNTAIN CREEK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-4501
Practice Address - Country:US
Practice Address - Phone:423-870-0036
Practice Address - Fax:423-870-0706
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0133532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0085717OtherBLUE CROSS BLUE SHEILD
3186307Medicare ID - Type Unspecified
TN0085717OtherBLUE CROSS BLUE SHEILD