MEDICARE: PULMONARY ASSOCIATES OF MIDDLE TENNESSEE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	MD0000025892	TN

General Provider Information

NPI Number	:	1518049063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULMONARY ASSOCIATES OF MIDDLE TENNESSEE PC

Provider Business Mailing Address
First Line	:	1801 N WASHINGTON ST
Second Line	:	SUITE 300
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-8245
Country	:	US
Telephone Number	:	931-455-1511
Fax Number	:	931-455-3001

Provider Business Practice Location Address
First Line	:	1801 N WASHINGTON ST
Second Line	:	SUITE 300
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-8245
Country	:	US
Telephone Number	:	931-455-1511
Fax Number	:	931-455-3001

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARY KEITH LOVELADY
Credential	:	MD
Telephone Number	:	931-455-1511

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	08/22/2020

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