Healthcare Provider Details

I. General information

NPI: 1154696243
Provider Name (Legal Business Name): ALEXANDER CLARK THURMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 HATCHER LN
COLUMBIA TN
38401-4827
US

IV. Provider business mailing address

1602 HATCHER LN
COLUMBIA TN
38401-4827
US

V. Phone/Fax

Practice location:
  • Phone: 931-388-0777
  • Fax: 931-388-1548
Mailing address:
  • Phone: 931-388-0777
  • Fax: 931-388-1548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number55977
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number55977
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number59026
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: