Provider Demographics
NPI:1841284445
Name:PREWITT, DARRION JEWAYNE (MD)
Entity type:Individual
Prefix:
First Name:DARRION
Middle Name:JEWAYNE
Last Name:PREWITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DARRION
Other - Middle Name:J
Other - Last Name:PREWITT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:17 CENTRE PLAZA DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2862
Mailing Address - Country:US
Mailing Address - Phone:731-512-0104
Mailing Address - Fax:731-512-0601
Practice Address - Street 1:503 E TICKLE ST
Practice Address - Street 2:SUITE C
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3165
Practice Address - Country:US
Practice Address - Phone:731-512-0104
Practice Address - Fax:731-512-0601
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD027357207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3073645OtherBLUE CROSS OF TN
3775116OtherCIGNA
110164227OtherPALMETTO GBA
115832OtherBETTER HEALTH PLAN
0440355OtherUNITED HEALTHCARE
5133201OtherAETNA
7126OtherTLC(MEMPHIS MANAGED CARE)
TN3807605Medicaid
115832OtherBETTER HEALTH PLAN
F86121Medicare UPIN