Individual
MRS. KATIE GREENE PEGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
490 DUNLOP LN, CLARKSVILLE, TN 37040-5007
(931) 245-8400
Mailing address
PO BOX 3799, CLARKSVILLE, TN 37043-3799
(931) 245-7000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
51676
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q028432
—
TN
Enumeration date
05/17/2011
Last updated
08/29/2022
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