Healthcare Provider Details

I. General information

NPI: 1376548040
Provider Name (Legal Business Name): KEVIN MAURICE DANSBY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 PEERLESS XING NW
CLEVELAND TN
37312-3784
US

IV. Provider business mailing address

7100 COMMERCE WAY SUITE 180
BRENTWOOD TN
37027-2829
US

V. Phone/Fax

Practice location:
  • Phone: 423-479-4165
  • Fax:
Mailing address:
  • Phone: 615-465-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0000001138
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: