Provider Demographics
NPI:1639170665
Name:RATLIFF, THOMAS WARREN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WARREN
Last Name:RATLIFF
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 1:7714 POPLAR AVE STE 200
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3941
Mailing Address - Country:US
Mailing Address - Phone:901-683-0055
Mailing Address - Fax:901-922-6722
Practice Address - Street 1:7945 WOLF RIVER BLVD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1762
Practice Address - Country:US
Practice Address - Phone:901-683-0055
Practice Address - Fax:901-685-2969
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31689207RH0003X
MS14362207RH0003X
ARE3185207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143951001Medicaid
7366016OtherAETNA
MS00122677Medicaid
TN3127676OtherBLUE CROSS BLUE SHIELD
TN3840320Medicaid
7157268OtherCIGNA
7157268OtherCIGNA
TN3127676OtherBLUE CROSS BLUE SHIELD
MS00122677Medicaid
AR5M187Medicare PIN
MS830000032Medicare PIN
7157268OtherCIGNA