Provider Demographics
NPI:1154393619
Name:LOVELACE, RANDY SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:SCOTT
Last Name:LOVELACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1225 E WEISGARBER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2675
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:1225 E WEISGARBER RD STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2675
Practice Address - Country:US
Practice Address - Phone:865-584-4747
Practice Address - Fax:865-584-1363
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD37328207RP1001X
IN01080443A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ020292Medicaid
TN3886016Medicare ID - Type Unspecified
TNH87894Medicare UPIN