Provider Demographics
NPI:1629001821
Name:CORLEW, RUTH DIANNE (PA)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:DIANNE
Last Name:CORLEW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:DIANNE
Other - Last Name:KNOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 STONECREST PKWY
Mailing Address - Street 2:STE 210
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6826
Mailing Address - Country:US
Mailing Address - Phone:615-625-7112
Mailing Address - Fax:615-625-7028
Practice Address - Street 1:1155 KENNEDY DR
Practice Address - Street 2:SUITE 201D
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2260
Practice Address - Country:US
Practice Address - Phone:615-849-1717
Practice Address - Fax:615-849-8858
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0091363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5442158Medicaid
TN3665220Medicare PIN