Healthcare Provider Details

I. General information

NPI: 1669640728
Provider Name (Legal Business Name): HERMITAGE MEDICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 COOL SPRINGS BLVD. SUITE 120
FRANKLIN TN
37067-6449
US

IV. Provider business mailing address

740 COOL SPRINGS BLVD. SUITE 120
FRANKLIN TN
37067-6449
US

V. Phone/Fax

Practice location:
  • Phone: 615-550-6200
  • Fax: 615-550-6099
Mailing address:
  • Phone: 615-550-6200
  • Fax: 615-550-6099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31405
License Number StateTN

VIII. Authorized Official

Name: DR. JOSEPH B OZENNE
Title or Position: PHYSICIAN/CEO
Credential: M.D.
Phone: 615-550-6200