Healthcare Provider Details

I. General information

NPI: 1922371749
Provider Name (Legal Business Name): BRENTWOOD PROFESSIONAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 POWELL PLACE
BRENTWOOD TN
37027
US

IV. Provider business mailing address

200 POWELL PLACE
BRENTWOOD TN
37027
US

V. Phone/Fax

Practice location:
  • Phone: 615-727-8416
  • Fax: 615-457-8094
Mailing address:
  • Phone: 615-727-8416
  • Fax: 615-457-8094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC2210
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDO1613
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW3696
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberME1237
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMD10148
License Number StateTN

VIII. Authorized Official

Name: MICHAEL CARTWRIGHT
Title or Position: BOARD PRESIDENT
Credential:
Phone: 615-642-6429