Healthcare Provider Details

I. General information

NPI: 1760612659
Provider Name (Legal Business Name): WATCHARASARN RATTANANAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2009
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S GIBSON RD APT 1208
HENDERSON NV
89012-2660
US

IV. Provider business mailing address

3 MARYLAND FARMS STE 200
BRENTWOOD TN
37027-5005
US

V. Phone/Fax

Practice location:
  • Phone: 615-345-5400
  • Fax: 888-468-6603
Mailing address:
  • Phone: 615-345-5400
  • Fax: 888-468-6603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD2019-0793
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number17053
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number17053
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: