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 | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | | MD019864 | TENNESSEE | No |
| 2 | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | | 32305 | SOUTH CAROLINA | No |
| 3 | 2086S0102X | Surgery | Surgical Critical Care | 32305 | SOUTH CAROLINA | 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 | 3068259 | MEDICARE ID-TYPE UNSPECIFIED | TENNESSEE | |
| 2 | P00910275 | OTHER | SOUTH CAROLINA | RAILROAD MC ID-RHI |
| 3 | 3030643 | OTHER | TENNESSEE | BCBS OF TN |
| 4 | 4221830 | OTHER | TENNESSEE | AETNA PPO |
| 5 | 3740032 | OTHER | TENNESSEE | UNITED HEALTHCARE |
| 6 | F31381 | MEDICARE UPIN | TENNESSEE | |
| 7 | 3296881005 | OTHER | TENNESSEE | CIGNA PPO |
| 8 | 3296881006 | OTHER | TENNESSEE | CIGNA HMO |
| 9 | 323055 | MEDICAID | SOUTH CAROLINA | |
| 10 | 3068258 | MEDICAID | TENNESSEE | |
| 11 | 0810895 | OTHER | TENNESSEE | AETNA HMO |
| 12 | F313819223 | MEDICARE PIN | SOUTH CAROLINA | |
