Healthcare Provider Details

I. General information

NPI: 1164579967
Provider Name (Legal Business Name): THOMAS BABCOCK IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6746 CHARLOTTE PIKE
NASHVILLE TN
37209
US

IV. Provider business mailing address

4608 INDIANA AVE
NASHVILLE TN
37209-2328
US

V. Phone/Fax

Practice location:
  • Phone: 615-647-9005
  • Fax:
Mailing address:
  • Phone: 615-604-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD0000043128
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: