Healthcare Provider Details

I. General information

NPI: 1346059011
Provider Name (Legal Business Name): VERSAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 MALLORY LN STE 308
FRANKLIN TN
37067-2843
US

IV. Provider business mailing address

1909 MALLORY LN STE 308
FRANKLIN TN
37067-2843
US

V. Phone/Fax

Practice location:
  • Phone: 615-203-8999
  • Fax: 615-373-1565
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PRAKASH VERMA
Title or Position: AUTHORIZED OFFICAL
Credential: MA
Phone: 615-203-8999