Healthcare Provider Details

I. General information

NPI: 1417404666
Provider Name (Legal Business Name): MUSIC CITY PEDS: DEVELOPMENTAL & BEHAVIORAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5409 MARYLAND WAY SUITE 202
BRENTWOOD TN
37027-5037
US

IV. Provider business mailing address

5409 MARYLAND WAY SUITE 202
BRENTWOOD TN
37027-5037
US

V. Phone/Fax

Practice location:
  • Phone: 615-373-9955
  • Fax: 615-373-2001
Mailing address:
  • Phone: 615-373-9955
  • Fax: 615-373-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number21660
License Number StateTN

VIII. Authorized Official

Name: MRS. CAITLIN NICHOLL RISSLER
Title or Position: NURSE PRACTITIONER/OWNER
Credential: NP
Phone: 615-207-7986