Healthcare Provider Details

I. General information

NPI: 1902899677
Provider Name (Legal Business Name): ALEXANDER J CHALKO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5653 FRIST BLVD SUITE 331
HERMITAGE TN
37076-2064
US

IV. Provider business mailing address

5653 FRIST BLVD SUITE 331
HERMITAGE TN
37076-2064
US

V. Phone/Fax

Practice location:
  • Phone: 615-889-4447
  • Fax: 615-889-5891
Mailing address:
  • Phone: 615-889-4447
  • Fax: 615-889-5891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD27017
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: