Provider Demographics
NPI:1417900820
Name:MCCRACKEN, DENNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:MCCRACKEN
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 1:710 CORNERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091
Mailing Address - Country:US
Mailing Address - Phone:931-994-5717
Mailing Address - Fax:931-246-4233
Practice Address - Street 1:710 CORNERSVILLE RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091
Practice Address - Country:US
Practice Address - Phone:931-994-5717
Practice Address - Fax:931-246-4233
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23683207P00000X
TNMD0000023683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3083239Medicaid
TN930056369OtherRAILROAD MEDICARE
TN3056626OtherBC
TN3056626OtherBLUE CROSS
TN930056369OtherRAILROAD MEDICARE
TN3083239Medicaid