| Organization Name: | LAKESIDE HEALTH CLINIC, P.C. |
| NPI Number: | 1336492495 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LISA HUBBARD (OWNER/PA-C) |
| Mailing Address: | 706 E Wood St Paris |
| State: | TN US |
| Postal Code: | 382424220 |
| Phone Number: | 7319242000 |
| Fax Number: | 7316530053 |
| NPI Enumeration Date: | 10/25/2012 |
| NPI Last Update Date: | 02/17/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |