Healthcare Provider Details

I. General information

NPI: 1962899450
Provider Name (Legal Business Name): PHILIP SEGRAVES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5408 REAGAN RUN
ANTIOCH TN
37013-5383
US

IV. Provider business mailing address

5408 REAGAN RUN
ANTIOCH TN
37013-5383
US

V. Phone/Fax

Practice location:
  • Phone: 615-573-4358
  • Fax:
Mailing address:
  • Phone: 615-573-4358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: