MEDICARE: DR. GARY B VERNA PH.D.

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	103TC0700X	Clinical Psychologist	P0000001449	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	352427000	OTHER	AETNA
2	TN0101	OTHER	JOHNDEERE HEALTHCARE
3	352427000	OTHER	MAGELLAN
4	4039056	OTHER	BLUECROSS BLUESHIELD
5	702009618	OTHER	CARITEN HEALTHCARE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619954781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY B VERNA PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 4818
Second Line	:
City	:	OAK RIDGE
State	:	TN
Zip	:	37831-4818
Country	:	US
Telephone Number	:	865-712-0234
Fax Number	:	423-562-6106

Provider Business Practice Location Address
First Line	:	300 W BEECH ST
Second Line	:	RM 1
City	:	LA FOLLETTE
State	:	TN
Zip	:	37766-3516
Country	:	US
Telephone Number	:	865-712-0234
Fax Number	:	423-562-6106

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	12/15/2013

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Directions to “ DR. GARY B VERNA PH.D.” Practice Location

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