Individual
DR. HOMER LEE STALEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
104 N LOCUST AVE, LAWRENCEBURG, TN 38464-3734
(931) 762-6476
(931) 762-1841
Mailing address
104 N LOCUST AVE, LAWRENCEBURG, TN 38464-3734
(931) 762-6476
(931) 762-1841
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD008952
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3170118
—
TN
Enumeration date
08/09/2006
Last updated
07/08/2007
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