Healthcare Provider Details

I. General information

NPI: 1568723088
Provider Name (Legal Business Name): DONALD BOATRIGHT, MD., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 W DUE WEST AVE STE 113
MADISON TN
37115-4428
US

IV. Provider business mailing address

607 W DUE WEST AVE STE 113
MADISON TN
37115-4428
US

V. Phone/Fax

Practice location:
  • Phone: 615-865-6269
  • Fax: 651-865-4169
Mailing address:
  • Phone: 615-865-6269
  • Fax: 651-865-4169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number16522
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number16522
License Number StateTN

VIII. Authorized Official

Name: DR. DONALD BOATRIGHT J BOATRIGHT
Title or Position: PHYSICIAN
Credential: MD
Phone: 615-865-6269