Provider Demographics
NPI:1891879193
Name:CALDWELL, THOMAS CONRAD JR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:CONRAD
Last Name:CALDWELL
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 1:2051 HAMILL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4026
Mailing Address - Country:US
Mailing Address - Phone:423-877-2844
Mailing Address - Fax:423-877-1959
Practice Address - Street 1:2051 HAMILL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4026
Practice Address - Country:US
Practice Address - Phone:423-877-2844
Practice Address - Fax:423-877-1959
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN017731208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3065950OtherBLUE CROSS PROVIDER ID
TN4034512OtherAETNA ID
TN4156364OtherBLUE CROSS ID
TN0000143907OtherUNITED HEALTHCARE ID
TN3028429Medicaid
TN3000262Medicaid
TN3065950OtherBLUE CROSS PROVIDER ID
TN3000262Medicaid
340017822Medicare PIN
TN4156364OtherBLUE CROSS ID
TN0000143907OtherUNITED HEALTHCARE ID