Provider Demographics
NPI:1679521058
Name:GARVIN, RICHARD P (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:GARVIN
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:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-0266
Mailing Address - Country:US
Mailing Address - Phone:615-459-5500
Mailing Address - Fax:615-459-5541
Practice Address - Street 1:429 NISSAN DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4366
Practice Address - Country:US
Practice Address - Phone:615-459-5500
Practice Address - Fax:615-459-5541
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3029982Medicaid
TN3711354Medicaid
TN3711354Medicare ID - Type UnspecifiedDR GARVIN
TN3711354Medicaid
TN3029982Medicare ID - Type UnspecifiedGP