Healthcare Provider Details

I. General information

NPI: 1770667289
Provider Name (Legal Business Name): MIDDLE TENNESSEE IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 N CHARLOTTE ST
DICKSON TN
37055-1009
US

IV. Provider business mailing address

PO BOX 306512
NASHVILLE TN
37230-6545
US

V. Phone/Fax

Practice location:
  • Phone: 615-446-8046
  • Fax:
Mailing address:
  • Phone: 615-851-6003
  • Fax: 615-948-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOCD0000000001
License Number StateTN

VIII. Authorized Official

Name: KAREN MARIE VAUGHN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 629-317-1465