Provider Demographics
NPI:1598750184
Name:DEJARNATT, ALAN C (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:C
Last Name:DEJARNATT
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 1:9800 SHELBYVILLE RD
Mailing Address - Street 2:STE 220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2992
Mailing Address - Country:US
Mailing Address - Phone:502-429-8585
Mailing Address - Fax:502-429-6157
Practice Address - Street 1:464 N PARKWAY
Practice Address - Street 2:SUITE D
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2810
Practice Address - Country:US
Practice Address - Phone:731-660-0138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19924207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3046212Medicaid
TN3046213Medicare ID - Type Unspecified
TN3046212Medicaid