Healthcare Provider Details

I. General information

NPI: 1508107376
Provider Name (Legal Business Name): PEDFORALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 THOROUGHBRED LN STE C
BRENTWOOD TN
37027-4234
US

IV. Provider business mailing address

5050 THOROUGHBRED LN STE C
BRENTWOOD TN
37027-4234
US

V. Phone/Fax

Practice location:
  • Phone: 615-982-2202
  • Fax:
Mailing address:
  • Phone: 615-982-2212
  • Fax: 615-334-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK DAVID HUGHES
Title or Position: OWNER/PROVIDER
Credential: M.D.
Phone: 615-517-6838