Provider Demographics
NPI:1740483767
Name:TIMOTHY K DUFFIN MD PLC
Entity type:Organization
Organization Name:TIMOTHY K DUFFIN MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:K
Authorized Official - Last Name:DUFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-553-2800
Mailing Address - Street 1:800 WEATHERLY DR
Mailing Address - Street 2:100-L
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8957
Mailing Address - Country:US
Mailing Address - Phone:931-553-2800
Mailing Address - Fax:931-553-0664
Practice Address - Street 1:800 WEATHERLY DRIVE
Practice Address - Street 2:100-L
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4521
Practice Address - Country:US
Practice Address - Phone:931-553-2800
Practice Address - Fax:931-553-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26846174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723229Medicaid
TN3723229Medicaid