Healthcare Provider Details

I. General information

NPI: 1992848816
Provider Name (Legal Business Name): CAROL WINFRED GUESS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CARL PERKINS PARKWAY
TIPTONVILLE TN
38079-1305
US

IV. Provider business mailing address

710 CARL PERKINS PARKWAY
TIPTONVILLE TN
38079
US

V. Phone/Fax

Practice location:
  • Phone: 731-253-6690
  • Fax:
Mailing address:
  • Phone: 731-253-6690
  • Fax: 731-253-6692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD17158
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: