Lisa a Weaver

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LISA A WEAVER

Doing business as

Eastside Family Medical Clinic

Practice address

104 Ivy LN
Pulaski, TN 38478-4550

Phone

(931) 424-1330

Fax

(931) 424-0019

NPI assigned

Nov 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Lisa Ann Weaver, APN

Title

Owner

Phone

(931) 424-1330

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• EASTSIDE FAMILY MEDICAL CLINIC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422835200000",
    "number": "1659447654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 IVY LN",
            "city": "PULASKI",
            "state": "TN",
            "postal_code": "384784550",
            "telephone_number": "931-424-1330",
            "fax_number": "931-424-0019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 IVY LN",
            "city": "PULASKI",
            "state": "TN",
            "postal_code": "384784550",
            "telephone_number": "931-424-1330",
            "fax_number": "931-424-0019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA A WEAVER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2015-02-02",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "931-424-1330",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "APN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3710887",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EASTSIDE FAMILY MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• James C Lathrop, MD
• Jodee C Lavoie
• Letha B Lee, R.PH.
• Lifecare Family Services
• Kandy Lynn Lindsey
• Constance Sabrina Long, P.A.
• David R Long, PHYSICAL THERAPIST
• Longs Physical Therapy Clinic
• Bethany Diane Lowry, DPT
• Todd Jefferson Lucas, MD

• Family Medicine Physician in Pulaski, TN
• Providers in Pulaski, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.