Healthcare Provider Details

I. General information

NPI: 1093757643
Provider Name (Legal Business Name): RIVERGATE PSYCHIATRIC & BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 WREN RD
GOODLETTSVILLE TN
37072-2316
US

IV. Provider business mailing address

815 WREN RD
GOODLETTSVILLE TN
37072-2316
US

V. Phone/Fax

Practice location:
  • Phone: 615-851-3063
  • Fax: 615-851-3048
Mailing address:
  • Phone: 615-851-3063
  • Fax: 615-851-3048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMAD SHAH JAHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 615-851-3063