Provider Demographics
NPI:1699814418
Name:EUBANKS, FRANKIE JOEL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:FRANKIE
Middle Name:JOEL
Last Name:EUBANKS
Suffix:
Gender:M
Credentials:CRNA
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 129
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-0129
Mailing Address - Country:US
Mailing Address - Phone:931-645-1199
Mailing Address - Fax:931-647-4358
Practice Address - Street 1:500 STIRLING RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-7722
Practice Address - Country:US
Practice Address - Phone:931-645-1199
Practice Address - Fax:931-647-4358
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000038334367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3600805Medicaid
TN300585980OtherTAX ID
TN3600805Medicare PIN