Healthcare Provider Details

I. General information

NPI: 1003975392
Provider Name (Legal Business Name): PSYCHIATRIC PRACTICE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6144 CUMBERLAND GAP PKWAY SUITE 1
HARROGATE TN
37752
US

IV. Provider business mailing address

6144 CUMBERLAND GAP PKWAY SUITE 1
HARROGATE TN
37752
US

V. Phone/Fax

Practice location:
  • Phone: 423-869-0383
  • Fax: 423-869-4587
Mailing address:
  • Phone: 423-869-0383
  • Fax: 423-869-4587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36004
License Number StateTN

VIII. Authorized Official

Name: DR. BILAL AHMED
Title or Position: MEMBER
Credential: M.D.
Phone: 423-869-0383