Healthcare Provider Details

I. General information

NPI: 1386899300
Provider Name (Legal Business Name): CORDOVA PSYCHIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 CORDOVA STATION AVE
CORDOVA TN
38018-6317
US

IV. Provider business mailing address

8289 CORDOVA RD #106
CORDOVA TN
38016
US

V. Phone/Fax

Practice location:
  • Phone: 901-737-4565
  • Fax: 901-737-4312
Mailing address:
  • Phone: 901-737-4565
  • Fax: 901-737-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberAPN0000007462
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARK ALLEN HESSELRODE
Title or Position: OWNER
Credential: APN
Phone: 901-737-4565