Provider Demographics
NPI:1184603854
Name:BOTTOMS, CATHERINE SIPE (MD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:SIPE
Last Name:BOTTOMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 PRESIDENT PL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6807
Mailing Address - Country:US
Mailing Address - Phone:615-223-5565
Mailing Address - Fax:615-223-5509
Practice Address - Street 1:741 PRESIDENT PL
Practice Address - Street 2:SUITE 210
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6807
Practice Address - Country:US
Practice Address - Phone:615-223-5565
Practice Address - Fax:615-223-5509
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0397102080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509789Medicaid
TN200412784OtherTIN
TN3334816Medicare ID - Type UnspecifiedMEDICARE
TN1509789Medicaid