Provider Demographics
NPI:1619954781
Name:VERNA, GARY B (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:B
Last Name:VERNA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4818
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37831-4818
Mailing Address - Country:US
Mailing Address - Phone:865-712-0234
Mailing Address - Fax:423-562-6106
Practice Address - Street 1:300 W BEECH ST
Practice Address - Street 2:RM 1
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3516
Practice Address - Country:US
Practice Address - Phone:865-712-0234
Practice Address - Fax:423-562-6106
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2013-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001449103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
352427000OtherAETNA
TN0101OtherJOHNDEERE HEALTHCARE
352427000OtherMAGELLAN
4039056OtherBLUECROSS BLUESHIELD
702009618OtherCARITEN HEALTHCARE
TN36835521Medicaid
TN3683555Medicaid
TN0101OtherJOHNDEERE HEALTHCARE
702009618OtherCARITEN HEALTHCARE
TN260315014OtherEIN
TN36835521Medicare PIN