Provider Demographics
NPI:1205882834
Name:CHILDRESS, DAVID RYAN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RYAN
Last Name:CHILDRESS
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 1:711 COOK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3486
Mailing Address - Country:US
Mailing Address - Phone:423-744-7585
Mailing Address - Fax:423-744-7075
Practice Address - Street 1:711 COOK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3486
Practice Address - Country:US
Practice Address - Phone:423-744-7585
Practice Address - Fax:423-744-7075
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38958207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00232041OtherRAILROAD MEDICARE
TN3898327Medicaid
TN4093024OtherBCBS OF TENNESSEE
TN4117405OtherBCBS
TN3898325Medicaid
TN4088721OtherBCBS
TN3898327Medicaid
TN4117405OtherBCBS
TN3898325Medicare ID - Type Unspecified