Basic Information
Provider Information
NPI: 1447243068
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GAINES
FirstName: THOMAS
MiddleName: EDWARD
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 440547
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372440547
CountryCode: US
TelephoneNumber: 8656706199
FaxNumber: 8656706188
Practice Location
Address1: 1940 ALCOA HWY
Address2: STE E-180
City: KNOXVILLE
State: TN
PostalCode: 379202244
CountryCode: US
TelephoneNumber: 8653056955
FaxNumber: 8656375216
Other Information
ProviderEnumerationDate: 08/30/2005
LastUpdateDate: 03/05/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208G00000X021056TNY Allopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery) 

No ID Information.


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