Provider Demographics
NPI:1174688790
Name:TURNER, AVIS DIANE (MD)
Entity Type:Individual
Prefix:MRS
First Name:AVIS
Middle Name:DIANE
Last Name:TURNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AVIS
Other - Middle Name:D
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1217 CHARLTON DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1360
Mailing Address - Country:US
Mailing Address - Phone:615-365-8425
Mailing Address - Fax:
Practice Address - Street 1:607 DUE WEST BLVD
Practice Address - Street 2:MEDICAL NECESSITIES, SUITE 113
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115
Practice Address - Country:US
Practice Address - Phone:615-865-6269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH34524Medicare UPIN
TN3861687Medicare ID - Type Unspecified