Provider Demographics
NPI:1801904503
Name:TEDDY, VIRGINIA A (MD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:A
Last Name:TEDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2535 MADISON ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-3920
Mailing Address - Country:US
Mailing Address - Phone:931-368-1153
Mailing Address - Fax:931-368-1150
Practice Address - Street 1:2535 MADISON ST
Practice Address - Street 2:SUITE D
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-3920
Practice Address - Country:US
Practice Address - Phone:931-368-1153
Practice Address - Fax:931-368-1150
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN204482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3072786Medicaid
TN4029755OtherBLUE CROSS BLUE SHIELD
TN4029755OtherBLUE CROSS BLUE SHIELD
TN3072786Medicaid