Provider Demographics
NPI:1144272576
Name:RAWL, DOUGLAS KIRKLAND (RPH)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:KIRKLAND
Last Name:RAWL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 NASHBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-3921
Mailing Address - Country:US
Mailing Address - Phone:615-636-5182
Mailing Address - Fax:
Practice Address - Street 1:1939 NASHBORO BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-3921
Practice Address - Country:US
Practice Address - Phone:615-636-5182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33502183500000X
GA054030208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA360483OtherWELLCARE
GARAW001OtherSECURE
GARAW001OtherSECURE
GA360483OtherWELLCARE