Provider Demographics
NPI:1982999694
Name:TITTLE, DENISE RENEE (DO)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:RENEE
Last Name:TITTLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3104
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-3104
Mailing Address - Country:US
Mailing Address - Phone:931-919-4894
Mailing Address - Fax:
Practice Address - Street 1:311 LANDRUM PL
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-6319
Practice Address - Country:US
Practice Address - Phone:931-919-4894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO2233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine