Provider Demographics
NPI:1548378805
Name:SUPPINGER, JEFFREY ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ANDREW
Last Name:SUPPINGER
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 1:4601 CAROTHERS PARKWAY
Mailing Address - Street 2:SUITE 225
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:615-794-5354
Mailing Address - Fax:615-599-3532
Practice Address - Street 1:4601 CAROTHERS PARKWAY
Practice Address - Street 2:SUITE 225
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067
Practice Address - Country:US
Practice Address - Phone:615-794-5354
Practice Address - Fax:615-599-3532
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD37628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3886951Medicaid
3886951Medicare ID - Type Unspecified
TN3886951Medicaid