Goran Djordje Antic, MD
Individual provider Active NPI Emergency Medicine Physician · Pulaski, TN
NPI 1124074752 · NPPES record last updated Nov 6, 2007
Key facts
- NPI
- 1124074752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 34506 (TN)
- Practice address
- 1265 E College St
Pulaski, TN 38478-4541 - Phone
- (931) 363-7531
- Fax
- (865) 291-3228
- NPI assigned
- May 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040115000539 | TN | Practitioner - Internal Medicine |
7618878414 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34506 | TN | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency Coverage, LLC | Emergency Medicine | Current |
Accepting new patients |
Locations
1607 S Locust Ave
Lawrenceburg, TN 38464
Phone (731) 287-2244
1265 E College St
Pulaski, TN 38478
Phone (931) 363-7531
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 34506 | TN | Yes |
Addresses
Primary practice location
1265 E College St
Pulaski, TN 38478-4541
Mailing address
PO Box 636019
Cincinnati, OH 45263-6019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00372629 | Other | TN | RAILROAD MEDICARE |
| 3859664 | Medicaid | TN | |
| 4072313 | Other | TN | BCBSTN |
Other providers in Pulaski, TN
- Amg-Hillside LLC
- Amg-Hillside LLC
- Amg-Hillside, LLC
- Amg-Hillside, LLC
- Angelic Caregivers
- Austin Hewitt House, LLC
- Lorraine C Bailey
- Zach Brewer Bailey
- Eresvita Balatico
- Ferdinand A. Balatico
All providers in Pulaski, TN · Emergency Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 6, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.