Basic Information
Provider Information
NPI: 1851992903
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIGHTEN
FirstName: DANISHIA
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1321 MURFREESBORO PIKE STE 702
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372172679
CountryCode: US
TelephoneNumber: 8443597629
FaxNumber: 6155775654
Practice Location
Address1: 1233 EAGLES LANDING PKWY
Address2:  
City: STOCKBRIDGE
State: GA
PostalCode: 302816399
CountryCode: US
TelephoneNumber: 4702311149
FaxNumber: 6158151946
Other Information
ProviderEnumerationDate: 11/05/2020
LastUpdateDate: 07/29/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/29/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X  Y    

No ID Information.


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