Provider Demographics
NPI:1023063989
Name:GHAVAM, CYRUS (MD)
Entity type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:
Last Name:GHAVAM
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 1:127 CRESTVIEW PARK DR STE 209
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2856
Mailing Address - Country:US
Mailing Address - Phone:615-446-5121
Mailing Address - Fax:
Practice Address - Street 1:127 CRESTVIEW PARK DR STE 209
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2856
Practice Address - Country:US
Practice Address - Phone:615-446-1308
Practice Address - Fax:615-441-4505
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61000908207X00000X
AL14668207XS0117X
TN49165207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51535248OtherBCBS
ALP00338937OtherRAILROAD MEDICARE
WA2149403Medicaid
AL009937579Medicaid
AL4520495OtherAETNA
$$$$$$$$$OtherTRICARE
AL4520495OtherAETNA