Healthcare Provider Details

I. General information

NPI: 1174669998
Provider Name (Legal Business Name): BERNARD T SY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 W BADDOUR PKWY
LEBANON TN
37087-2513
US

IV. Provider business mailing address

1407 W BADDOUR PKWY
LEBANON TN
37087-2513
US

V. Phone/Fax

Practice location:
  • Phone: 615-444-6203
  • Fax: 615-444-6252
Mailing address:
  • Phone: 615-444-6203
  • Fax: 615-444-6252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number42650
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42650
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: