Healthcare Provider Details

I. General information

NPI: 1871417683
Provider Name (Legal Business Name): EVERGREEN HEALTHCARE TENNESSEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 BENTON AVE UNIT 311
NASHVILLE TN
37204-2684
US

IV. Provider business mailing address

445 BENTON AVE UNIT 311
NASHVILLE TN
37204-2684
US

V. Phone/Fax

Practice location:
  • Phone: 315-415-3546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number
License Number State

VIII. Authorized Official

Name: FREMLIN DEKYI JR.
Title or Position: CEO
Credential: MD
Phone: 917-428-8463