Provider Demographics
NPI:1780648972
Name:LOVELACE, DONALD R (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:LOVELACE
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 1:215 E SPRINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1761
Mailing Address - Country:US
Mailing Address - Phone:423-392-6370
Mailing Address - Fax:423-530-7900
Practice Address - Street 1:2002 BROOKSIDE DR STE 300
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4634
Practice Address - Country:US
Practice Address - Phone:423-392-6370
Practice Address - Fax:423-392-6081
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD14203207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ003370Medicaid
TN3195006Medicaid
VA1780648972Medicaid
TN3195006Medicaid
TNQ003370Medicaid
VA1780648972Medicaid
TNQ003370Medicaid
TN160044442OtherRR MCARE