Healthcare Provider Details

I. General information

NPI: 1659808426
Provider Name (Legal Business Name): NASHVILLE WELLNESS CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000A CHURCH ST E
BRENTWOOD TN
37027
US

IV. Provider business mailing address

9000A CHURCH ST E
BRENTWOOD TN
37027
US

V. Phone/Fax

Practice location:
  • Phone: 731-861-0994
  • Fax: 615-645-9606
Mailing address:
  • Phone: 731-861-0994
  • Fax: 615-645-9606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIKE COLEMAN
Title or Position: GENERAL MANAGER
Credential:
Phone: 731-861-0994