Provider Demographics
NPI:1013238856
Name:PINKSTON, GAVIN BUTLER (MD)
Entity Type:Individual
Prefix:
First Name:GAVIN
Middle Name:BUTLER
Last Name:PINKSTON
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 1:626 BLUE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-6111
Mailing Address - Country:US
Mailing Address - Phone:931-626-8245
Mailing Address - Fax:
Practice Address - Street 1:1222 TROTWOOD AVE STE 108
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6404
Practice Address - Country:US
Practice Address - Phone:931-380-4066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32845207Q00000X
TN50275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine