Provider Demographics
NPI:1902991433
Name:NASHVILLE NEUROSCIENCE GROUP
Entity Type:Organization
Organization Name:NASHVILLE NEUROSCIENCE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JOHNSON-HIETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-284-4680
Mailing Address - Street 1:300 20TH AVE N
Mailing Address - Street 2:STE 106
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:615-284-4680
Mailing Address - Fax:615-284-4681
Practice Address - Street 1:300 20TH AVE N
Practice Address - Street 2:STE 106
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-284-4680
Practice Address - Fax:615-284-4681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22045174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3714571Medicare PIN
TN3075036Medicare PIN