Provider Demographics
NPI:1871594952
Name:PRATT, EDWARD STEPHEN (MD)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:STEPHEN
Last Name:PRATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2120 EXETER RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3922
Mailing Address - Country:US
Mailing Address - Phone:901-507-2225
Mailing Address - Fax:901-507-7890
Practice Address - Street 1:2120 EXETER RD
Practice Address - Street 2:SUITE 130
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3922
Practice Address - Country:US
Practice Address - Phone:901-507-2225
Practice Address - Fax:901-507-7890
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD 14529207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A98481Medicare UPIN
TN3021030Medicare ID - Type Unspecified