Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Gonzalo Rafael De Villa, MD

Individual provider Family Medicine Physician · NPI 1053845545

Dr. Gonzalo Rafael De Villa, MD is a Family Practice in Clinton, Tennessee. Qualified in 2017, 9 years ago. Practices with Covenant Medical Group Inc, a 356-clinician group and accepts Medicare assignment. Licensed in Tennessee.

Years since qualifying
9
Licensed in
TN
In the registry since
2017
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

102 S Charles G Seivers Blvd
Clinton, TN 37716-3916
Phone: (865) 457-4702
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 61482 (TN)

Record details

NPI number1053845545
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 12, 2017
Last updated in NPPESApril 27, 2021
Certification dateApril 27, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Covenant Medical Group Inc — 356 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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