Basic Information
| Provider Information | |||||||||
| NPI: | 1730138355 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARUTHERS | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 97 EMILY CV | ||||||||
| Address2: | |||||||||
| City: | ATOKA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380047475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014630072 | ||||||||
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| Practice Location | |||||||||
| Address1: | 629 NUCKOLLS RD | ||||||||
| Address2: | |||||||||
| City: | BOLIVAR | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380081599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316583388 | ||||||||
| FaxNumber: | 7316581719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 04/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | TN000029623 | TN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 174400000X | TN0000029623 | TN | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 3810696 | 05 | TN | MEDICAID | 1730138355 | 01 | NPI | OTHER |