Provider Demographics
NPI:1164961553
Name:LOVETT, PAYNE
Entity Type:Individual
Prefix:
First Name:PAYNE
Middle Name:
Last Name:LOVETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W 4TH AVE
Mailing Address - Street 2:P.O. BOX 4056
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-2106
Mailing Address - Country:US
Mailing Address - Phone:865-776-7191
Mailing Address - Fax:423-569-1423
Practice Address - Street 1:134 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-2106
Practice Address - Country:US
Practice Address - Phone:865-776-7191
Practice Address - Fax:423-569-1423
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0013173343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ019513Medicaid