Provider Demographics
NPI:1659360352
Name:CHURCHWELL, LUELLA GRIGG (MD)
Entity Type:Individual
Prefix:DR
First Name:LUELLA
Middle Name:GRIGG
Last Name:CHURCHWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 CORDOVA CV
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2200
Mailing Address - Country:US
Mailing Address - Phone:901-753-2794
Mailing Address - Fax:901-753-8876
Practice Address - Street 1:1335 CORDOVA CV
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2200
Practice Address - Country:US
Practice Address - Phone:901-753-2794
Practice Address - Fax:901-753-8876
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD18578207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3068672Medicaid
TN3018898OtherBCBS
TN3068672Medicaid
TN3068672Medicare ID - Type Unspecified