Provider Demographics
NPI:1063520666
Name:TERNOVITS, CRAIG ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ANDREW
Last Name:TERNOVITS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:53 CENTURY BLOVD
Mailing Address - Street 2:STE 120
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3693
Mailing Address - Country:US
Mailing Address - Phone:615-346-6213
Mailing Address - Fax:615-346-6225
Practice Address - Street 1:3901 CENTRAL PIKE STE 555
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3491
Practice Address - Country:US
Practice Address - Phone:615-874-9667
Practice Address - Fax:615-871-9682
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
TNMD38785208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114241Medicaid