Provider Demographics
NPI:1801819198
Name:DILLARD, DONNA R (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:DILLARD
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 1:150 W PRICE RD
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-4524
Mailing Address - Country:US
Mailing Address - Phone:865-475-6161
Mailing Address - Fax:865-475-9857
Practice Address - Street 1:150 W PRICE RD
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-4524
Practice Address - Country:US
Practice Address - Phone:865-475-6161
Practice Address - Fax:865-475-9857
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3101882OtherBLUE CROSS BLUE SHIELD
TN3712179Medicaid
TNTN0107OtherJOHN DEERE HEALTH CARE
TN1505854Medicaid
3101882OtherBLUE CROSS BLUE SHIELD
F82083Medicare UPIN
TN38247101Medicare PIN