Healthcare Provider Details

I. General information

NPI: 1497700231
Provider Name (Legal Business Name): NASHVILLE SKIN AND CANCER, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 21ST AVE S
NASHVILLE TN
37212-4908
US

IV. Provider business mailing address

2301 21ST AVE S
NASHVILLE TN
37212-4908
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-9797
  • Fax: 615-613-0329
Mailing address:
  • Phone: 615-327-9797
  • Fax: 615-613-0329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LUZ E HERNANDEZ
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 615-327-9797