Provider Demographics
NPI:1568406783
Name:GARRETSON, ROLAND F (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:F
Last Name:GARRETSON
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 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2245
Practice Address - Country:US
Practice Address - Phone:615-396-4694
Practice Address - Fax:615-396-6751
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52307207RG0100X
MS10649207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07902595Medicaid
AL110327Medicaid
AL156644Medicaid
MSP01236963OtherRAILROAD MEDICARE
MSP00142931Medicare PIN
MS302I103082Medicare PIN
MSP00613958Medicare PIN
MS512I100002Medicare PIN
MS100000172Medicare ID - Type Unspecified
MS07902595Medicaid