Healthcare Provider Details

I. General information

NPI: 1548333099
Provider Name (Legal Business Name): CLARKSVILLE PULMONARY & CRITICAL CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 LANDRUM PL SUITE 700
CLARKSVILLE TN
37043
US

IV. Provider business mailing address

311 LANDRUM PL SUITE 700
CLARKSVILLE TN
37043
US

V. Phone/Fax

Practice location:
  • Phone: 931-648-8314
  • Fax: 931-647-3841
Mailing address:
  • Phone: 931-648-8314
  • Fax: 931-647-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number25152
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25152
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JATIN K KADAKIA
Title or Position: DOCTOR
Credential: MD
Phone: 931-648-8314