Provider Demographics
NPI:1770508756
Name:ANDERSON, HUNT DANDRIDGE (MD)
Entity type:Individual
Prefix:DR
First Name:HUNT
Middle Name:DANDRIDGE
Last Name:ANDERSON
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 1:100 LANTANA RD STE 202A
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-1915
Mailing Address - Country:US
Mailing Address - Phone:931-484-5141
Mailing Address - Fax:
Practice Address - Street 1:100 LANTANA RD STE 202A
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-1915
Practice Address - Country:US
Practice Address - Phone:931-484-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA60036207RC0000X
GA060036207RI0011X
TN65924207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ076975Medicaid
GA003152712DMedicaid
GA202I069871Medicare PIN