Provider Demographics
NPI:1174729735
Name:GUERRANT, RICHARD P III (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:GUERRANT
Suffix:III
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 1:1995 HIGHWAY 51 S STE 111
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-3654
Mailing Address - Country:US
Mailing Address - Phone:901-475-6607
Mailing Address - Fax:901-475-6612
Practice Address - Street 1:1995 HIGHWAY 51 S
Practice Address - Street 2:SUITE 111
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-3635
Practice Address - Country:US
Practice Address - Phone:901-475-6607
Practice Address - Fax:901-475-6612
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD015822207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3050723Medicaid
TN3050723Medicaid
E35270Medicare UPIN