1184634214 NPI number — DR. LORI M PROCTOR MD

Table of content: DR. LORI M PROCTOR MD (NPI 1184634214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184634214 NPI number — DR. LORI M PROCTOR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PROCTOR
Provider First Name:
LORI
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184634214
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5301 VIRGINIA WAY
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-7541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-695-4977
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5301 VIRGINIA WAY
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
BRENTWOOD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37027-7541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-695-4977
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  41842 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 55427 . This is a "GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 164669500 . This is a "BLACK LUNG" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 164669500 . This is a "DOL" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 675737865 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4149079 . This is a "BCBS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 41842 . This is a "TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3000029 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8272039 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 52207348 . This is a "BCBS OF GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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