Provider Demographics
NPI:1396288650
Name:PANEZICH, LAUREN RENE (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:RENE
Last Name:PANEZICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:RENE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:102 S CHARLES G SEIVERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-3916
Mailing Address - Country:US
Mailing Address - Phone:865-457-4702
Mailing Address - Fax:865-374-2115
Practice Address - Street 1:102 S CHARLES G SEIVERS BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-3916
Practice Address - Country:US
Practice Address - Phone:865-457-4702
Practice Address - Fax:865-374-2115
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.36850207Q00000X
ALL.4372R207Q00000X
TN59405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ049891Medicaid