Healthcare Provider Details

I. General information

NPI: 1790304368
Provider Name (Legal Business Name): CAROLINE FULLER PRESCOTT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 SEABOARD LN STE 2021
BRENTWOOD TN
37027-3031
US

IV. Provider business mailing address

PO BOX 26194
BELFAST ME
04915-2012
US

V. Phone/Fax

Practice location:
  • Phone: 615-261-1210
  • Fax: 833-973-3532
Mailing address:
  • Phone: 865-584-4747
  • Fax: 865-212-3718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number67597
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: