Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 2084N0400X | Psychiatry & Neurology | Neurology | MD09195 | TENNESSEE | No |
| 2 | 2084P0805X | Psychiatry & Neurology | Geriatric Psychiatry | MD09195 | TENNESSEE | No |
| 3 | 2084P0800X | Psychiatry & Neurology | Psychiatry | MD09195 | TENNESSEE | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1205830536 | OTHER | TENNESSEE | NPI |
| 2 | 3159564 | OTHER | TENNESSEE | BLUE CROSS BLUE SHIELD OF |
| 3 | 621837879 | OTHER | UTAH | INITED HEALTH CARE |
| 4 | 3036274 | MEDICAID | TENNESSEE | |
| 5 | 621837879 | OTHER | NORTH CAROLINA | CBHA CAROLINA BEHAVIORAL |
| 6 | 21699743 | OTHER | MISSOURI | GEHA |
| 7 | 621837870 | OTHER | TENNESSEE | UNITED BEHAVIORAL HEALTH |
| 8 | 621837879 | OTHER | NORTH CAROLINA | CM ADMINISTRATORS IN |
| 9 | C46964 | MEDICARE UPIN | TENNESSEE | |
| 10 | 421837879 | OTHER | TENNESSEE | CARITEN SENIOR HEALTH |
| 11 | 621837879 | OTHER | NEW JERSEY | AIG CLAIM SVS WORKER COM |
| 12 | 219709 | OTHER | VIRGINIA | TRIGON BC/BS |
| 13 | 260046091 | OTHER | GEORGIA | PALMETTO GBA |
| 14 | 621837879-0002 | OTHER | TENNESSEE | CIGNA HEALTH CARE |
| 15 | 1205830536 | MEDICAID | TENNESSEE | |
| 16 | 1205830536 | MEDICARE OSCAR/CERTIFICATION | TENNESSEE | |
| 17 | 621837879 | OTHER | FLORIDA | HORIZON HEALTH |
| 18 | 621837879 | OTHER | ILLINOIS | BANKERS LIFE |
| 19 | 3036274 | MEDICARE OSCAR/CERTIFICATION | TENNESSEE | |
| 20 | 621837879-01 | OTHER | ILLINOIS | JOHN DEERE HEALTH CARE |
| 21 | 621837879 | OTHER | TENNESSEE | CONTINENTAL LIFE |
| 22 | 621837879 | OTHER | FLORIDA | AMERICAN GENERAL LIFE |
| 23 | 7104511 | OTHER | VIRGINIA | MEDICAID VA7104511 |
| 24 | NPI | MEDICAID | TENNESSEE | |
