Individual
GORAN DJORDJE ANTIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1265 E COLLEGE ST, PULASKI, TN 38478-4541
(931) 363-7531
(865) 291-3228
Mailing address
PO BOX 636019, CINCINNATI, OH 45263-6019
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34506
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3859664
—
TN
01
—
4072313
BCBSTN
TN
01
—
P00372629
RAILROAD MEDICARE
TN
Enumeration date
05/25/2006
Last updated
11/06/2007
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