Provider Demographics
NPI:1851837652
Name:GIFFORD, JERALD CRAIG
Entity Type:Individual
Prefix:
First Name:JERALD
Middle Name:CRAIG
Last Name:GIFFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 MARK ALLEN LN STE G
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-5556
Mailing Address - Country:US
Mailing Address - Phone:662-871-7270
Mailing Address - Fax:844-414-0376
Practice Address - Street 1:1411 MARK ALLEN LN STE G
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-5556
Practice Address - Country:US
Practice Address - Phone:662-871-7270
Practice Address - Fax:844-414-0376
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNORT0000000099222Z00000X
TNPRO0000000077224P00000X
TNCPO2599335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist