Healthcare Provider Details

I. General information

NPI: 1134700859
Provider Name (Legal Business Name): CAREBRIDGE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HUDSON ST FL 21
JERSEY CITY NJ
07302-3929
US

IV. Provider business mailing address

501 GREAT CIRCLE RD
NASHVILLE TN
37228-1317
US

V. Phone/Fax

Practice location:
  • Phone: 615-436-9060
  • Fax: 615-235-9725
Mailing address:
  • Phone: 615-436-9060
  • Fax: 615-235-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MELINDA SHAW HENDERSON
Title or Position: PRESIDENT
Credential:
Phone: 615-585-1181