Healthcare Provider Details

I. General information

NPI: 1831169382
Provider Name (Legal Business Name): RIVER RADIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 CROSSINGS CIRCLE
MT. JULIET TN
37122
US

IV. Provider business mailing address

200 SIGNATURE PLACE
LEBANON TN
37087
US

V. Phone/Fax

Practice location:
  • Phone: 615-444-2320
  • Fax: 615-449-3163
Mailing address:
  • Phone: 615-444-2320
  • Fax: 615-449-3163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateTN

VIII. Authorized Official

Name: DEBBIE DISMUKES
Title or Position: PRACTICE ADMIN
Credential:
Phone: 615-444-2320