Provider Demographics
NPI:1841201886
Name:SUPPINGER, AMY MARIE (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:SUPPINGER
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 1:4601 CAROTHERS PARKWAY
Mailing Address - Street 2:SUITE 225
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:615-794-5354
Mailing Address - Fax:615-599-3532
Practice Address - Street 1:4601 CAROTHERS PARKWAY
Practice Address - Street 2:SUITE 225
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067
Practice Address - Country:US
Practice Address - Phone:615-794-5354
Practice Address - Fax:615-599-3532
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD37452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3886933Medicaid
3886933Medicare ID - Type Unspecified
TN3886933Medicaid