MEDICARE: EARL DWAYNE LETT M.D.

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	174400000X	Specialist	MD25738	TN
2	2086S0122X	Plastic and Reconstructive Surgery Physician	MD25738	TN

General Provider Information

NPI Number	:	1790757755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARL DWAYNE LETT M.D.

Provider Business Mailing Address
First Line	:	410 42ND AVE N STE 400
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-3658
Country	:	US
Telephone Number	:	615-329-7887
Fax Number	:	615-346-6225

Provider Business Practice Location Address
First Line	:	660 S MOUNT JULIET RD STE 210
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-3973
Country	:	US
Telephone Number	:	615-443-0901
Fax Number	:	615-442-0310

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	08/25/2023

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