Provider Demographics
NPI:1922155910
Name:T ALLEN POLK MD
Entity Type:Organization
Organization Name:T ALLEN POLK MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TALMADGE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-890-4810
Mailing Address - Street 1:1034 N HIGHLAND AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2463
Mailing Address - Country:US
Mailing Address - Phone:615-890-4810
Mailing Address - Fax:615-895-4391
Practice Address - Street 1:1034 N HIGHLAND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2463
Practice Address - Country:US
Practice Address - Phone:615-890-4810
Practice Address - Fax:615-895-4391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA99079Medicare UPIN
TN3719714Medicare ID - Type Unspecified