Provider Demographics
NPI:1609808062
Name:VERNE, G NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:G
Middle Name:NICHOLAS
Last Name:VERNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:G.
Other - Middle Name:NICHOLAS
Other - Last Name:VERNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:877 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2807
Mailing Address - Country:US
Mailing Address - Phone:901-515-4541
Mailing Address - Fax:901-545-8122
Practice Address - Street 1:880 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3409
Practice Address - Country:US
Practice Address - Phone:901-515-4541
Practice Address - Fax:901-545-8122
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089794207RG0100X
TN60200207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2750410Medicaid
OHVE4207101Medicare PIN
OH2750410Medicaid