Provider Demographics
NPI:1851337893
Name:MORTON, RANDALL T (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:T
Last Name:MORTON
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 1:501 ADESSA PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-6725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 ADESSA PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-6725
Practice Address - Country:US
Practice Address - Phone:865-549-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19458207Q00000X
TNMD194582083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3045185Medicaid
TNP00243207OtherRR MEDICARE PIN
TNP00243207OtherRR MEDICARE PIN