Healthcare Provider Details

I. General information

NPI: 1508991456
Provider Name (Legal Business Name): MIDDLE TENNESSEE MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6011 TROTWOOD AVE SUITE 400
COLUMBIA TN
38401-7009
US

IV. Provider business mailing address

6011 TROTWOOD AVE SUITE 400
COLUMBIA TN
38401-7009
US

V. Phone/Fax

Practice location:
  • Phone: 931-388-9663
  • Fax: 931-388-7411
Mailing address:
  • Phone: 931-388-9663
  • Fax: 931-388-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTY MORTON MASH
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 931-388-9663