Provider Demographics
NPI:1669406500
Name:GAW, RANDY A (MD)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:A
Last Name:GAW
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 1:140 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1726
Mailing Address - Country:US
Mailing Address - Phone:931-783-5582
Mailing Address - Fax:931-526-6760
Practice Address - Street 1:145 W 4TH ST STE 201
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2476
Practice Address - Country:US
Practice Address - Phone:931-783-4901
Practice Address - Fax:931-783-4991
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD000000158272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1531621Medicaid
TN4351476OtherBCBS
KY7100434210Medicaid
TN103I130574Medicare PIN
TN4351476OtherBCBS