Healthcare Provider Details

I. General information

NPI: 1225407232
Provider Name (Legal Business Name): MICHAEL A. BOGGESS, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2015
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 OVERLOOK CIR SUITE B-3
BRENTWOOD TN
37027-3291
US

IV. Provider business mailing address

4072 TRAIL RIDGE DR
FRANKLIN TN
37067-4057
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 TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number44489
License Number StateTN

VIII. Authorized Official

Name: MICHAEL ALLEN BOGGESS
Title or Position: OWNER
Credential: M.D.
Phone: 615-942-8016