Active NPI
Virginia A Teddy, MD
- Psychiatry Physician
- Clarksville, TN
National Provider Identifier
1801904503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- TN20448
- Practice address
- 2535 Madison St
Suite D
Clarksville, TN 37043-3920 - Phone
- (931) 368-1153
- Fax
- (931) 368-1150
- NPI assigned
- Aug 25, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | TN20448 | TN | Primary |
Addresses
Primary practice location
2535 Madison St
Suite D
Clarksville, TN 37043-3920
Mailing address
2535 Madison St
Suite D
Clarksville, TN 37043-3920
Phone (931) 368-1153
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3072786 | Medicaid | TN | |
| 4029755 | Other | TN | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TN20448 | TN | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clarksville Family Therapy | Past | Accepting new patients | |
| Madison Behavioral Health, LLC | Psychiatry | Past | Accepting new patients |
| Madison Behavioral Health, LLC | Psychiatry | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Clarksville, TN
- NPI 1861753105
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1801904503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2535 MADISON ST",
"address_2": "SUITE D",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370433920",
"telephone_number": "931-368-1153",
"fax_number": "931-368-1150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2535 MADISON ST",
"address_2": "SUITE D",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370433920",
"telephone_number": "931-368-1153",
"fax_number": "931-368-1150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEDDY",
"first_name": "VIRGINIA",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TN",
"license": "TN20448",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3072786",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "4029755",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.