Provider Demographics
NPI:1518223130
Name:RENO, JUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:RENO
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 1:300 STEAM PLANT RD.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066
Mailing Address - Country:US
Mailing Address - Phone:615-328-3750
Mailing Address - Fax:615-328-3758
Practice Address - Street 1:300 STEAM PLANT RD.
Practice Address - Street 2:SUITE 300
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-328-3750
Practice Address - Fax:615-328-3758
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD52547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ013966Medicaid
TNQ013966Medicaid
TN3380640OtherGROUP MEDICIAD