Healthcare Provider Details

I. General information

NPI: 1598720880
Provider Name (Legal Business Name): GRACE LAVERA SCHULTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 S CHURCH ST STE 601
MURFREESBORO TN
37130-4980
US

IV. Provider business mailing address

745 S CHURCH ST STE 601
MURFREESBORO TN
37130-4980
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-7404
  • Fax: 423-495-2625
Mailing address:
  • Phone: 615-767-9954
  • Fax: 219-506-7653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number31887
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0000031887
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: