Provider Demographics
NPI:1417909086
Name:ATKINS, KEITH LANTRIP (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:LANTRIP
Last Name:ATKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176C W UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1616
Mailing Address - Country:US
Mailing Address - Phone:731-660-6915
Mailing Address - Fax:731-668-4557
Practice Address - Street 1:176C W UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1616
Practice Address - Country:US
Practice Address - Phone:731-660-6915
Practice Address - Fax:731-668-4557
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD26528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3090749Medicaid
TNG01880Medicare UPIN
TN3090749Medicare ID - Type Unspecified