Healthcare Provider Details

I. General information

NPI: 1982767646
Provider Name (Legal Business Name): NASHVILLE PERIODONTAL GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 21ST AVE S
NASHVILLE TN
37212-4314
US

IV. Provider business mailing address

2000 21ST AVE S
NASHVILLE TN
37212-4314
US

V. Phone/Fax

Practice location:
  • Phone: 615-385-3334
  • Fax: 615-385-3335
Mailing address:
  • Phone: 615-385-3334
  • Fax: 615-385-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6906
License Number StateTN

VIII. Authorized Official

Name: DR. BILLY WAYNE AKIN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 615-385-3334