Healthcare Provider Details

I. General information

NPI: 1609971134
Provider Name (Legal Business Name): RICHARD A COLLETTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 HOLIDAY CT., D10
FRANKLIN TN
37067
US

IV. Provider business mailing address

109 HOLIDAY CT D-09
FRANKLIN TN
37067-3000
US

V. Phone/Fax

Practice location:
  • Phone: 615-636-1188
  • Fax: 888-381-3549
Mailing address:
  • Phone: 615-636-1188
  • Fax: 888-381-3549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number41367
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101254453
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA83081
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier262016109
Identifier TypeOTHER
Identifier StateTN
Identifier IssuerTAX ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: