Provider Demographics
NPI:1851385108
Name:DENTON, RANDY LEE JR (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:LEE
Last Name:DENTON
Suffix:JR
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 1:1855 TANNER WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-8331
Mailing Address - Country:US
Mailing Address - Phone:865-376-6272
Mailing Address - Fax:865-374-2100
Practice Address - Street 1:1855 TANNER WAY STE 200
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8331
Practice Address - Country:US
Practice Address - Phone:865-376-6272
Practice Address - Fax:865-374-2100
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23983207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ066114Medicaid
TN3086338Medicaid
TN3086338Medicare PIN
TN110239411Medicare PIN