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NPI Code Detail

MEDICARE: PETER THOMAS GARDNER MD

MEDICARE: PETER THOMAS GARDNER MD
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
1390200000XStudent in an Organized Health Care Education/Training Program26391TN
2208D00000XGeneral Practice PhysicianMD26391TN

General Provider Information

NPI Number : 1821127093
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER THOMAS GARDNER MD
Provider Business Mailing Address
First Line : PO BOX 12197
Second Line : DEPT
City : JACKSON
State : TN
Zip : 38308-0136
Country : US
Telephone Number : 731-984-8400
Fax Number : 731-984-8305
Provider Business Practice Location Address
First Line : 2075 PLEASANT PLAINS EXT RD
Second Line :
City : JACKSON
State : TN
Zip : 38305-6087
Country : US
Telephone Number : 731-984-8400
Fax Number : 731-984-8305
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 06/29/2011

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