Healthcare Provider Details

I. General information

NPI: 1174628523
Provider Name (Legal Business Name): NICHOLAS ALEXANDER TSAMBASSIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 DEAN DRIVE
CLARKSVILLE TN
37040-3981
US

IV. Provider business mailing address

127 DEAN DRIVE
CLARKSVILLE TN
37040-3981
US

V. Phone/Fax

Practice location:
  • Phone: 931-906-9473
  • Fax: 931-906-9477
Mailing address:
  • Phone: 931-906-9473
  • Fax: 931-906-9477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberMD-019687
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-019687
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: