Provider Demographics
NPI:1790729986
Name:PRATT, MARTHA ANN (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:PRATT
Suffix:
Gender:F
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 634706
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:865-292-3000
Mailing Address - Fax:
Practice Address - Street 1:200 STONECREST BLVD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6810
Practice Address - Country:US
Practice Address - Phone:615-768-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37287207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4151422OtherBLUECROSS
TN3882360Medicaid
TN3882369Medicaid
TNP00384367OtherRAILROAD MEDICARE
TN4110139OtherBLUECROSS
TN4151422OtherBLUECROSS
H81409Medicare UPIN
TN3882369Medicare PIN