Healthcare Provider Details

I. General information

NPI: 1679112734
Provider Name (Legal Business Name): MERHAWE TESFAMICHAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 DICKERSON PIKE
NASHVILLE TN
37207-4564
US

IV. Provider business mailing address

2401 DICKERSON PIKE
NASHVILLE TN
37207-4564
US

V. Phone/Fax

Practice location:
  • Phone: 615-582-3291
  • Fax:
Mailing address:
  • Phone: 615-582-3291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: