Provider Demographics
NPI:1437302874
Name:CHURCHILL, CAROL ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL ANN
Middle Name:
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROL ANN
Other - Middle Name:
Other - Last Name:RISSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1719 GALLATIN PIKE N
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2123
Mailing Address - Country:US
Mailing Address - Phone:615-870-0143
Mailing Address - Fax:615-870-5524
Practice Address - Street 1:1719 GALLATIN PIKE N
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2123
Practice Address - Country:US
Practice Address - Phone:615-870-0143
Practice Address - Fax:615-870-5524
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000029955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine