Provider Demographics
NPI:1841517109
Name:BUTLER, MIRANDA RAINES (MD)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:RAINES
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MIRANDA
Other - Middle Name:DANELLE
Other - Last Name:RAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:648 HARTSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2523
Mailing Address - Country:US
Mailing Address - Phone:615-451-9246
Mailing Address - Fax:
Practice Address - Street 1:426 22ND AVE E
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3711
Practice Address - Country:US
Practice Address - Phone:615-451-9246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49940208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics