Provider Demographics
NPI:1174590780
Name:LINVILLE, DOUGLAS A (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:A
Last Name:LINVILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 NORTHEAST EXPRESSWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3976
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3240 NORTHEAST EXPRESSWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:ATANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-3976
Practice Address - Country:US
Practice Address - Phone:404-480-9330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA80785207X00000X
TNMD33869207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125519Medicaid
TN4922880001OtherCIGNA GOVERNMENT DME
TN3854143Medicaid
TN4036605OtherBCBST
TN3377615Medicaid
TN3377615Medicaid
TN4922880001OtherCIGNA GOVERNMENT DME
TN3854145Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE