Provider Demographics
NPI:1053394916
Name:BEATTY, DOUGLAS CRAIG (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CRAIG
Last Name:BEATTY
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 1:693 PRESIDENT PL
Mailing Address - Street 2:103
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-8600
Mailing Address - Country:US
Mailing Address - Phone:615-223-6900
Mailing Address - Fax:615-223-9441
Practice Address - Street 1:693 PRESIDENT PL
Practice Address - Street 2:103
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-8600
Practice Address - Country:US
Practice Address - Phone:615-223-6900
Practice Address - Fax:615-223-9441
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38126191OtherMEDICARE ID
TN3812619Medicaid
TNA92853Medicare UPIN