Healthcare Provider Details

I. General information

NPI: 1609439694
Provider Name (Legal Business Name): NATHANIEL THEODORE KOUTLAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 08/07/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1146 FRANCK ST 101
ALCOA TN
37701
US

IV. Provider business mailing address

PO BOX 306556
NASHVILLE TN
37230-6556
US

V. Phone/Fax

Practice location:
  • Phone: 865-694-7725
  • Fax:
Mailing address:
  • Phone: 615-329-2294
  • Fax: 615-695-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number74215
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: