Individual
MR. DONATHAN M IVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 LANTANA ROAD, SUITE 202, CROSSVILLE, TN 38555-1903
(931) 484-5141
(931) 484-5620
Mailing address
100 LANTANA ROAD, SUITE 202, CROSSVILLE, TN 38555-1903
(931) 484-5141
(931) 484-5620
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD10079
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3185096
—
TN
01
—
406021123
RAILROAD MEDICARE
—
01
—
58256
BLUE CROSS
TN
Enumeration date
08/22/2006
Last updated
12/08/2009
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