Provider Demographics
NPI:1922089903
Name:CORRIE, GARY DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DOUGLAS
Last Name:CORRIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:G.
Other - Middle Name:DOUGLAS
Other - Last Name:COORIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:822 MCARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355
Mailing Address - Country:US
Mailing Address - Phone:931-723-7121
Mailing Address - Fax:931-723-7133
Practice Address - Street 1:822 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355
Practice Address - Country:US
Practice Address - Phone:931-723-7121
Practice Address - Fax:931-723-7133
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37542208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3884761Medicaid
TN3884761Medicaid
3884761Medicare PIN