Provider Demographics
NPI:1538367610
Name:CHIPMAN, LAUREN TUCKER (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:TUCKER
Last Name:CHIPMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-4925
Mailing Address - Country:US
Mailing Address - Phone:901-481-5787
Mailing Address - Fax:
Practice Address - Street 1:4095 AMERICAN WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-8339
Practice Address - Country:US
Practice Address - Phone:901-271-9500
Practice Address - Fax:901-271-9501
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46086208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518519Medicaid