Provider Demographics
NPI:1619057528
Name:LOVELADY, GARY KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:KEITH
Last Name:LOVELADY
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 1:1801 N WASHINGTON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-8245
Mailing Address - Country:US
Mailing Address - Phone:931-455-1511
Mailing Address - Fax:931-455-3001
Practice Address - Street 1:1801 N WASHINGTON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-8245
Practice Address - Country:US
Practice Address - Phone:931-455-1511
Practice Address - Fax:931-455-3001
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000025892207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3006786OtherBLUE CROSS OF TENNESSEE
TN3086005Medicaid
TN3086005Medicaid
TN3006786OtherBLUE CROSS OF TENNESSEE