Provider Demographics
NPI:1437130903
Name:SCATES, PAUL E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:SCATES
Suffix:JR
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:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-0399
Mailing Address - Country:US
Mailing Address - Phone:901-466-0250
Mailing Address - Fax:901-466-0738
Practice Address - Street 1:12995 HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-6115
Practice Address - Country:US
Practice Address - Phone:901-466-0250
Practice Address - Fax:901-466-0738
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD16599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3022250Medicaid
TN3022258Medicare ID - Type UnspecifiedCIGNA MEDICARE
TN443933Medicare ID - Type UnspecifiedRIVERBEND MEDICARE
TND71839Medicare UPIN