Healthcare Provider Details

I. General information

NPI: 1619954781
Provider Name (Legal Business Name): GARY B VERNA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 12/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W BEECH ST RM 1
LA FOLLETTE TN
37766-3516
US

IV. Provider business mailing address

PO BOX 4818
OAK RIDGE TN
37831-4818
US

V. Phone/Fax

Practice location:
  • Phone: 865-712-0234
  • Fax: 423-562-6106
Mailing address:
  • Phone: 865-712-0234
  • Fax: 423-562-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP0000001449
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: