Healthcare Provider Details

I. General information

NPI: 1437421146
Provider Name (Legal Business Name): DYNAMIC MEDICAL CENTER OF MURFREESBORO PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 ROBERT ROSE DR STE D
MURFREESBORO TN
37129-6365
US

IV. Provider business mailing address

210 ROBERT ROSE DR STE D
MURFREESBORO TN
37129-6365
US

V. Phone/Fax

Practice location:
  • Phone: 615-225-9100
  • Fax: 615-225-9105
Mailing address:
  • Phone: 615-225-9100
  • Fax: 615-225-9105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. COLEEN MARIE CARBERRY
Title or Position: MANAGER
Credential:
Phone: 484-883-4761