Provider Demographics
NPI:1689628745
Name:UPCHURCH, TIMOTHY PURNELL (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PURNELL
Last Name:UPCHURCH
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 1:123 UPCHURCH LN
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:38560-4135
Mailing Address - Country:US
Mailing Address - Phone:610-664-2584
Mailing Address - Fax:610-664-3501
Practice Address - Street 1:110 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2008
Practice Address - Country:US
Practice Address - Phone:423-328-0363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120135622084V0102X, 2084N0400X
UT12662573-12052084V0102X
IL0361328972084V0102X, 2084N0400X
IAMD501052084V0102X
TN436872084V0102X
OK425222084V0102X
WAMD613365192084V0102X
MI43011111812084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN43687OtherMEDICAL LICENSE NUMBER