# LISA A WEAVER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** EASTSIDE FAMILY MEDICAL CLINIC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659447654
- **Authorized official:** MS. LISA ANN WEAVER APN (OWNER)
- **Authorized official phone:** (931) 424-1330

## Contact information

- **Practice address:** 104 IVY LN, PULASKI, TN 38478-4550
- **Practice address phone:** (931) 424-1330
- **Practice address fax:** (931) 424-0019
- **Mailing address:** 104 IVY LN, PULASKI, TN 38478-4550
- **Mailing address phone:** (931) 424-1330
- **Mailing address fax:** (931) 424-0019

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/28/2006
- **Last updated:** 02/02/2015