Healthcare Provider Details

I. General information

NPI: 1609899673
Provider Name (Legal Business Name): GRESHAM & ASSOCIATES CARDIOLOGY GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 S CHURCH ST STE A130
MURFREESBORO TN
37130-4919
US

IV. Provider business mailing address

745 S CHURCH ST STE A130
MURFREESBORO TN
37130-4919
US

V. Phone/Fax

Practice location:
  • Phone: 615-295-2411
  • Fax: 615-617-3249
Mailing address:
  • Phone: 615-295-2411
  • Fax: 615-617-3249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD024607
License Number StateTN

VIII. Authorized Official

Name: DR. TINA COVINGTON GRESHAM
Title or Position: PRINCIPAL
Credential: M.D.
Phone: 615-295-2411