Healthcare Provider Details

I. General information

NPI: 1235170010
Provider Name (Legal Business Name): REGIONAL ENT ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206A BABB DR
LEBANON TN
37087-2508
US

IV. Provider business mailing address

206A BABB DR
LEBANON TN
37087-2508
US

V. Phone/Fax

Practice location:
  • Phone: 615-444-6667
  • Fax: 615-444-7058
Mailing address:
  • Phone: 615-444-6667
  • Fax: 615-444-7058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD021696
License Number StateTN

VIII. Authorized Official

Name: DR. JOHN L TATE
Title or Position: PRESIDENT
Credential: M. D.
Phone: 615-444-6667