Provider Demographics
NPI:1992848816
Name:GUESS, CAROL WINFRED (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:WINFRED
Last Name:GUESS
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 1:710 CARL PERKINS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:TIPTONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38079
Mailing Address - Country:US
Mailing Address - Phone:731-253-6690
Mailing Address - Fax:731-253-6692
Practice Address - Street 1:710 CARL PERKINS PARKWAY
Practice Address - Street 2:
Practice Address - City:TIPTONVILLE
Practice Address - State:TN
Practice Address - Zip Code:38079-1305
Practice Address - Country:US
Practice Address - Phone:731-253-6690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNC70365Medicare UPIN