Provider Demographics
NPI:1962487157
Name:LARSON, TIM VERNON (MD)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:VERNON
Last Name:LARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1923 SULPHUR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-5654
Mailing Address - Country:US
Mailing Address - Phone:423-317-9344
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:5600 BRAINERD RD STE A4
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5336
Practice Address - Country:US
Practice Address - Phone:423-266-4588
Practice Address - Fax:865-342-0103
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD296922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
4102995OtherBLUE CROSS BLUE SHIELD
TN3820357Medicaid
F66463Medicare UPIN
F66463Medicare UPIN