Provider Demographics
NPI:1689816142
Name:LOVE, TIMOTHY PHILIP (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PHILIP
Last Name:LOVE
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 1:1710 WHEELER DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3546
Mailing Address - Country:US
Mailing Address - Phone:404-769-0326
Mailing Address - Fax:
Practice Address - Street 1:700 W FOREST AVE
Practice Address - Street 2:STE 300
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3937
Practice Address - Country:US
Practice Address - Phone:731-422-0310
Practice Address - Fax:731-422-0475
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD54665208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery