Healthcare Provider Details

I. General information

NPI: 1619057528
Provider Name (Legal Business Name): GARY KEITH LOVELADY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N WASHINGTON ST SUITE 300
TULLAHOMA TN
37388-8245
US

IV. Provider business mailing address

1801 N WASHINGTON ST SUITE 300
TULLAHOMA TN
37388-8245
US

V. Phone/Fax

Practice location:
  • Phone: 931-455-1511
  • Fax: 931-455-3001
Mailing address:
  • Phone: 931-455-1511
  • Fax: 931-455-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD0000025892
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: