Provider Demographics
NPI:1346203783
Name:DONALDSON, RICHARD
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051B HAMILL RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4093
Mailing Address - Country:US
Mailing Address - Phone:423-870-4400
Mailing Address - Fax:423-870-8281
Practice Address - Street 1:2051B HAMILL RD
Practice Address - Street 2:SUITE 210
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4093
Practice Address - Country:US
Practice Address - Phone:423-870-4400
Practice Address - Fax:423-870-8281
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6961204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4049435OtherBLUE CROSS BLUE SHIELD
TN3173936Medicaid
TNBO3633Medicare UPIN
TN3173936Medicaid
TN4833420001Medicare NSC