MEDICARE: CREATIVE HEALTHCARE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35619	TN

General Provider Information

NPI Number	:	1205072303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE HEALTHCARE, PLLC

Provider Business Mailing Address
First Line	:	1836 CROMWELL DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-5616
Country	:	US
Telephone Number	:	615-309-9982
Fax Number	:

Provider Business Practice Location Address
First Line	:	1836 CROMWELL DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-5616
Country	:	US
Telephone Number	:	615-309-9982
Fax Number	:

Authorized Official
Title or Position	:	C.E.O.
Name	:	DR. JEAN RAINES LESSLY
Credential	:	M.D.
Telephone Number	:	615-309-9982

Provider Enumeration Date	:	12/21/2008
Last Update Date	:	05/12/2009

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