Healthcare Provider Details

I. General information

NPI: 1073007456
Provider Name (Legal Business Name): NAKEDA MIDDLETON BURROW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TYLER CT
GALLATIN TN
37066
US

IV. Provider business mailing address

100 TYLER CT
GALLATIN TN
37066-4207
US

V. Phone/Fax

Practice location:
  • Phone: 615-593-8105
  • Fax:
Mailing address:
  • Phone: 615-593-8105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: