Healthcare Provider Details

I. General information

NPI: 1235637109
Provider Name (Legal Business Name): MEHTA CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 MAIN ST N
CARTHAGE TN
37030-1208
US

IV. Provider business mailing address

74 LEBANON HWY
CARTHAGE TN
37030-2954
US

V. Phone/Fax

Practice location:
  • Phone: 615-735-8002
  • Fax:
Mailing address:
  • Phone: 615-735-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEMAL MEHTA
Title or Position: PHYSICIAN
Credential: MD
Phone: 615-735-8002