Healthcare Provider Details

I. General information

NPI: 1780401190
Provider Name (Legal Business Name): GENEXSURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019A GALBRAITH DR
NASHVILLE TN
37215-3406
US

IV. Provider business mailing address

6339 CHARLOTTE PIKE # 918
NASHVILLE TN
37209-2926
US

V. Phone/Fax

Practice location:
  • Phone: 615-933-6014
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State

VIII. Authorized Official

Name: PRADEEP RAO
Title or Position: CHIEF PRODUCT OFFICER
Credential:
Phone: 615-933-6014