Provider Demographics
NPI:1720198104
Name:RICHARD P GUERRANT MD
Entity Type:Organization
Organization Name:RICHARD P GUERRANT MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PUTNEY
Authorized Official - Last Name:GUERRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-475-6607
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019
Mailing Address - Country:US
Mailing Address - Phone:901-475-6607
Mailing Address - Fax:901-475-6612
Practice Address - Street 1:1995 HIGHWAY 51 SOUTH
Practice Address - Street 2:SUITE 111
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019
Practice Address - Country:US
Practice Address - Phone:901-475-6607
Practice Address - Fax:901-475-6612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD015822207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3050723Medicaid
TN116514OtherUNISON HEALTHCARE
TN165608OtherTENNCARE SELECT
E35270Medicare UPIN
TN165608OtherTENNCARE SELECT