Healthcare Provider Details

I. General information

NPI: 1225253883
Provider Name (Legal Business Name): KEITH LOU ANTHONY PERKINS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1947 MADISON ST STE B
CLARKSVILLE TN
37043-8033
US

IV. Provider business mailing address

1947 MADISON ST STE B
CLARKSVILLE TN
37043-8033
US

V. Phone/Fax

Practice location:
  • Phone: 931-614-7169
  • Fax: 877-958-9018
Mailing address:
  • Phone: 931-614-7169
  • Fax: 877-958-9018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46862
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46862
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: