Healthcare Provider Details

I. General information

NPI: 1104829027
Provider Name (Legal Business Name): CYRUS C ERICKSON III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 MALLORY LN STE 302
FRANKLIN TN
37067-2843
US

IV. Provider business mailing address

PO BOX 58326
NASHVILLE TN
37205-8326
US

V. Phone/Fax

Practice location:
  • Phone: 615-771-3033
  • Fax: 615-771-3029
Mailing address:
  • Phone: 615-771-3033
  • Fax: 615-771-0398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number39029
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number39029
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: