Provider Demographics
NPI:1053431015
Name:PAPILLION, PAUL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:PAPILLION
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 1:1909 MALLORY LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2830
Mailing Address - Country:US
Mailing Address - Phone:615-771-7718
Mailing Address - Fax:
Practice Address - Street 1:1909 MALLORY LN
Practice Address - Street 2:SUITE 104
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2830
Practice Address - Country:US
Practice Address - Phone:615-771-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43030T208200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4185212OtherBCBSTN THRU APPALACHIAN MEDICAL SVCS
TN30009272Medicare PIN
TN1507233Medicaid
TNP00667680OtherRAILROAD MCARE
TN3400017Medicaid