Provider Demographics
NPI:1396816997
Name:BAIN, VERNA (MD)
Entity Type:Individual
Prefix:MS
First Name:VERNA
Middle Name:
Last Name:BAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-1228
Mailing Address - Country:US
Mailing Address - Phone:615-325-5000
Mailing Address - Fax:615-323-8400
Practice Address - Street 1:105 E MARKET ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1228
Practice Address - Country:US
Practice Address - Phone:615-325-5000
Practice Address - Fax:615-323-8400
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31162207R00000X, 207RA0401X, 207RS0012X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3840998Medicaid
KY64071749Medicaid
KY64071749Medicaid
TNBB6309808OtherDEA
TN3840998Medicaid
TNBB6309808OtherDEA