Healthcare Provider Details

I. General information

NPI: 1619080470
Provider Name (Legal Business Name): STEVEN DALE HEAD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 CENTRAL PIKE STE 353
HERMITAGE TN
37076-3422
US

IV. Provider business mailing address

3024 BUSINESS PARK CIR
GOODLETTSVILLE TN
37072-3132
US

V. Phone/Fax

Practice location:
  • Phone: 615-220-8788
  • Fax: 615-220-8688
Mailing address:
  • Phone: 615-239-2018
  • Fax: 615-239-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDPM268
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: