Healthcare Provider Details

I. General information

NPI: 1043285729
Provider Name (Legal Business Name): PLATEAU PEDIATRICS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3234 MILLER AVE
CROSSVILLE TN
38555-6116
US

IV. Provider business mailing address

3234 MILLER AVE
CROSSVILLE TN
38555-6116
US

V. Phone/Fax

Practice location:
  • Phone: 931-707-8700
  • Fax: 931-456-0802
Mailing address:
  • Phone: 931-707-8700
  • Fax: 931-456-0802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number3899812
License Number StateTN

VIII. Authorized Official

Name: SUZANNE K BERMAN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 931-707-8700