Healthcare Provider Details

I. General information

NPI: 1982386629
Provider Name (Legal Business Name): NATHAN DANIEL HOPKINS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WASHINGTON ST W STE A
FAYETTEVILLE TN
37334-2872
US

IV. Provider business mailing address

2314 MINGO RD
WINCHESTER TN
37398-3631
US

V. Phone/Fax

Practice location:
  • Phone: 931-433-3231
  • Fax:
Mailing address:
  • Phone: 931-636-5207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12228
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: