Healthcare Provider Details

I. General information

NPI: 1164415543
Provider Name (Legal Business Name): RICHARD A. BAGBY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 HOSPITAL RD STE G
WINCHESTER TN
37398-2470
US

IV. Provider business mailing address

183 HOSPITAL RD STE G
WINCHESTER TN
37398-2470
US

V. Phone/Fax

Practice location:
  • Phone: 931-962-2272
  • Fax: 931-962-8588
Mailing address:
  • Phone: 931-962-2272
  • Fax: 931-967-8119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMDO11925
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: