Provider Demographics
NPI:1720096159
Name:CASADY, BETH ANN (DO FAAFP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:CASADY
Suffix:
Gender:F
Credentials:DO FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37381-4010
Mailing Address - Country:US
Mailing Address - Phone:423-365-2171
Mailing Address - Fax:423-365-5456
Practice Address - Street 1:225 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:TN
Practice Address - Zip Code:37381-4010
Practice Address - Country:US
Practice Address - Phone:423-365-2171
Practice Address - Fax:423-365-5456
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3302741Medicaid
TN3302741Medicaid
TN103I084510Medicare PIN