Healthcare Provider Details

I. General information

NPI: 1205827565
Provider Name (Legal Business Name): DANIEL J SHERWOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 FAIRVIEW BLVD STE 100
FAIRVIEW TN
37062-9458
US

IV. Provider business mailing address

127 CRESTVIEW PARK DR STE 209
DICKSON TN
37055-2856
US

V. Phone/Fax

Practice location:
  • Phone: 629-205-3018
  • Fax: 629-205-3020
Mailing address:
  • Phone: 615-446-5121
  • Fax: 615-446-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE4946
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number57869
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: