Provider Demographics
NPI:1972603710
Name:DASH, LAMARR ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:LAMARR
Middle Name:ANTONIO
Last Name:DASH
Suffix:
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 1:100 COVEY DR
Mailing Address - Street 2:307
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5665
Mailing Address - Country:US
Mailing Address - Phone:615-791-1170
Mailing Address - Fax:615-791-1172
Practice Address - Street 1:100 COVEY DR
Practice Address - Street 2:307
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5665
Practice Address - Country:US
Practice Address - Phone:615-791-1170
Practice Address - Fax:615-791-1172
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD13768207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0016608OtherBLUE CROSS BLUE SHIELD
TN16608Medicaid
TN0016608OtherBLUE CROSS BLUE SHIELD