Provider Demographics
NPI:1558476358
Name:TURNER, ROLAND DEWAYNE (BOCP)
Entity Type:Individual
Prefix:MR
First Name:ROLAND
Middle Name:DEWAYNE
Last Name:TURNER
Suffix:
Gender:M
Credentials:BOCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CYPRESS POINT CV
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060
Mailing Address - Country:US
Mailing Address - Phone:901-465-5926
Mailing Address - Fax:901-577-7468
Practice Address - Street 1:50 CYPRESS POINT CV
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:TN
Practice Address - Zip Code:38060-4652
Practice Address - Country:US
Practice Address - Phone:901-465-5926
Practice Address - Fax:901-577-7468
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
TN8174400000X
TN9174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCFO00957OtherCERTIFIED ORTHOTIC FITTER
TNC22328OtherCERTIFIED PROSTHETIST