Healthcare Provider Details

I. General information

NPI: 1679078299
Provider Name (Legal Business Name): KAVEH ZOLFAGHARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 11/09/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 FIRST BOULEVARD
HERMITAGE TN
37076
US

IV. Provider business mailing address

709 CHESTERFIELD WAY
NASHVILLE TN
37212-4031
US

V. Phone/Fax

Practice location:
  • Phone: 615-316-4901
  • Fax:
Mailing address:
  • Phone: 615-284-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number63810
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: