Provider Demographics
NPI:1649286873
Name:NINER, PAUL J III (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:NINER
Suffix:III
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 1:4126 CHANCELLOR DR
Mailing Address - Street 2:
Mailing Address - City:THOMPSONS STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37179-5310
Mailing Address - Country:US
Mailing Address - Phone:615-838-2566
Mailing Address - Fax:
Practice Address - Street 1:621 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOHENWALD
Practice Address - State:TN
Practice Address - Zip Code:38462-1355
Practice Address - Country:US
Practice Address - Phone:931-796-3245
Practice Address - Fax:931-796-2315
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD19376207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3326246Medicaid
TN3326242Medicaid
TNE39258Medicare UPIN
TN3326246Medicaid