Provider Demographics
NPI:1457325730
Name:PERRY, GERSHON Y (MD, FACC)
Entity Type:Individual
Prefix:DR
First Name:GERSHON
Middle Name:Y
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD, FACC
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 21731
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424
Mailing Address - Country:US
Mailing Address - Phone:423-778-7156
Mailing Address - Fax:423-634-8050
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:SUITE A 350
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-778-7156
Practice Address - Fax:423-634-8050
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD026032207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3088102Medicaid
TN3088102Medicare ID - Type Unspecified
E84602Medicare UPIN