Healthcare Provider Details

I. General information

NPI: 1760456313
Provider Name (Legal Business Name): DANIEL S JAVIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 8TH ST
CLARKSVILLE TN
37040-3093
US

IV. Provider business mailing address

PO BOX 198721
NASHVILLE TN
37219-8721
US

V. Phone/Fax

Practice location:
  • Phone: 931-920-7200
  • Fax: 931-920-7202
Mailing address:
  • Phone: 615-463-7577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD25432
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: