Healthcare Provider Details

I. General information

NPI: 1558438424
Provider Name (Legal Business Name): JOSEPH A LITTLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 GATEWAY BLVD. SUITE 110
MURFREESBORO TN
37129
US

IV. Provider business mailing address

1370 GATEWAY BLVD. SUITE 110
MURFREESBORO TN
37129
US

V. Phone/Fax

Practice location:
  • Phone: 615-890-9008
  • Fax: 615-890-0193
Mailing address:
  • Phone: 615-890-9008
  • Fax: 615-890-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD012307
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3105630
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: