Provider Demographics
NPI:1659426955
Name:QUALLS, C EDWARD (PSYD)
Entity type:Individual
Prefix:DR
First Name:C
Middle Name:EDWARD
Last Name:QUALLS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6106 MARTINGALE LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5712
Mailing Address - Country:US
Mailing Address - Phone:615-513-5248
Mailing Address - Fax:615-284-4679
Practice Address - Street 1:762 E ARGYLE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-5024
Practice Address - Country:US
Practice Address - Phone:615-513-5248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP2026103G00000X, 103T00000X
MAPSY5000037103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3688199Medicaid
TN3688199Medicaid