NPIMap

Organization Active NPI

Tullahoma Neurodiagnostic Clinic PC

  • Neurology Physician
  • Tullahoma, TN
National Provider Identifier
1548249527
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
30044 Issued in TN
Legal business name
TULLAHOMA NEURODIAGNOSTIC CLINIC PC
Practice address
1330 Cedar LN
Suite 700
Tullahoma, TN 37388-2283
Phone
(931) 455-1219
Fax
(931) 393-3394
NPI assigned
Jan 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Raymond L Capps, MDNPI 1346444742
Title
Physician
Phone
(931) 455-1219

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X 30044 TN Primary

Addresses

Primary practice location

1330 Cedar LN
Suite 700
Tullahoma, TN 37388-2283

Mailing address

1330 Cedar LN
Suite 700
Tullahoma, TN 37388-2283
Phone (931) 455-1219

Other identifiers 2

IdentifierTypeStateIssuer
3726745MedicaidTN
3115407OtherTNBCBS

National Provider Directory

National Provider Directory

Locations

1330 Cedar Ln
Ste 700
Tullahoma, TN 37388
Phone (931) 455-1219

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1548249527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 CEDAR LN",
            "address_2": "SUITE 700",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373882283",
            "telephone_number": "931-455-1219",
            "fax_number": "931-393-3394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 CEDAR LN",
            "address_2": "SUITE 700",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373882283",
            "telephone_number": "931-455-1219",
            "fax_number": "931-393-3394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TULLAHOMA NEURODIAGNOSTIC CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CAPPS",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "931-455-1219",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TN",
            "license": "30044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3726745",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "3115407",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tullahoma, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.