Healthcare Provider Details

I. General information

NPI: 1366708356
Provider Name (Legal Business Name): GREGORY CARPENTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

1310 24TH AVE S
NASHVILLE TN
37212-2637
US

V. Phone/Fax

Practice location:
  • Phone: 615-873-7003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number52156
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number52156
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: