Provider Demographics
NPI:1518049063
Name:PULMONARY ASSOCIATES OF MIDDLE TENNESSEE PC
Entity Type:Organization
Organization Name:PULMONARY ASSOCIATES OF MIDDLE TENNESSEE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:LOVELADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-455-1511
Mailing Address - Street 1:1801 N WASHINGTON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-8245
Mailing Address - Country:US
Mailing Address - Phone:931-455-1511
Mailing Address - Fax:931-455-3001
Practice Address - Street 1:1801 N WASHINGTON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-8245
Practice Address - Country:US
Practice Address - Phone:931-455-1511
Practice Address - Fax:931-455-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000025892207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3719503Medicare ID - Type Unspecified