Provider Demographics
NPI:1184634214
Name:PROCTOR, LORI M (MD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:M
Last Name:PROCTOR
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 1:5301 VIRGINIA WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7541
Mailing Address - Country:US
Mailing Address - Phone:615-695-4977
Mailing Address - Fax:
Practice Address - Street 1:5301 VIRGINIA WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7541
Practice Address - Country:US
Practice Address - Phone:615-695-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41842207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55427OtherGA
TN164669500OtherBLACK LUNG
TN164669500OtherDOL
GA675737865Medicaid
TN4149079OtherBCBS OF TN
TN41842OtherTN
TN3000029Medicaid
TN8272039OtherCIGNA
GA52207348OtherBCBS OF GA
TN4149079OtherBCBS OF TN
TN164669500OtherBLACK LUNG
TN41842OtherTN
TN8272039OtherCIGNA