Healthcare Provider Details

I. General information

NPI: 1962317602
Provider Name (Legal Business Name): PRIVIA MEDICAL GROUP TENNESSEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 GARRISON DR
MURFREESBORO TN
37129-2570
US

IV. Provider business mailing address

3715 NORTHSIDE PARKWAY, BUILDING 100 STE 550
ATLANTA GA
30327
US

V. Phone/Fax

Practice location:
  • Phone: 770-312-5226
  • Fax:
Mailing address:
  • Phone: 770-312-5226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MARY L ROLLER
Title or Position: SR DIRECTOR PROVIDER ENROLLMENT
Credential:
Phone: 770-312-5226