Provider Demographics
NPI:1720088974
Name:BUCHANAN, ERNEST GROVER IV (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:GROVER
Last Name:BUCHANAN
Suffix:IV
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 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:833-908-0998
Practice Address - Street 1:1101 NEAL ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0901
Practice Address - Country:US
Practice Address - Phone:931-528-7797
Practice Address - Fax:931-372-0098
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3831523Medicaid
TN3831523Medicaid
3831523Medicare PIN