Provider Demographics
NPI:1083779235
Name:FLOYD, JERRY RAY (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:RAY
Last Name:FLOYD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8507 HWY 51 N
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-1535
Mailing Address - Country:US
Mailing Address - Phone:901-873-2555
Mailing Address - Fax:901-873-2561
Practice Address - Street 1:8507 US HIGHWAY 51 N
Practice Address - Street 2:SUITE 107
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-1535
Practice Address - Country:US
Practice Address - Phone:901-873-2555
Practice Address - Fax:901-873-2561
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000028821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3378384Medicaid
TN3378384Medicaid
TNG53357Medicare UPIN
TN3378384Medicare ID - Type Unspecified