Provider Demographics
NPI:1811124340
Name:LAPOLLO, JUSTIN (DO)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:LAPOLLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:220 ATHENS WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1351
Mailing Address - Country:US
Mailing Address - Phone:615-320-1155
Mailing Address - Fax:615-320-1177
Practice Address - Street 1:10133 SHERRILL BLVD STE 220
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-3775
Practice Address - Country:US
Practice Address - Phone:615-320-1155
Practice Address - Fax:615-320-1177
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26672084P0800X
HIDOS-13642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ066264Medicaid