Provider Demographics
NPI:1699776658
Name:GILLESPIE, CHRIS L (MD)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:L
Last Name:GILLESPIE
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 1:2095 EXETER RD
Mailing Address - Street 2:SUITE 80-266
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3963
Mailing Address - Country:US
Mailing Address - Phone:901-844-1434
Mailing Address - Fax:901-844-1439
Practice Address - Street 1:1861 OLD TOWNE LN
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38139-6411
Practice Address - Country:US
Practice Address - Phone:901-844-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3178161Medicaid
TN3178161Medicare PIN
TNB59404Medicare UPIN
TN3178161Medicaid