Healthcare Provider Details

I. General information

NPI: 1912973249
Provider Name (Legal Business Name): MICHAEL A. BOGGESS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 11/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 OVERLOOK CIR STE B3
BRENTWOOD TN
37027-3241
US

IV. Provider business mailing address

213 OVERLOOK CIR STE B3
BRENTWOOD TN
37027-3241
US

V. Phone/Fax

Practice location:
  • Phone: 615-942-8016
  • Fax: 615-739-5376
Mailing address:
  • Phone: 615-942-8016
  • Fax: 615-739-5376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number31982
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number44489
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: