Provider Demographics
NPI:1730265901
Name:EMBREE, STANLEY (DPM)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:EMBREE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 NEW SHACKLE ISLAND RD STE 203A
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2371
Mailing Address - Country:US
Mailing Address - Phone:615-822-9651
Mailing Address - Fax:
Practice Address - Street 1:353 NEW SHACKLE ISLAND RD STE 203A
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2371
Practice Address - Country:US
Practice Address - Phone:615-822-9651
Practice Address - Fax:615-822-9655
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM184213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3350647Medicaid
T61066Medicare UPIN
TN3350647Medicaid