Healthcare Provider Details

I. General information

NPI: 1518699461
Provider Name (Legal Business Name): MUSIC CITY FOOT AND WOUND CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 MURPHY AVE STE 215
NASHVILLE TN
37203-1803
US

IV. Provider business mailing address

2201 MURPHY AVE STE 215
NASHVILLE TN
37203-1803
US

V. Phone/Fax

Practice location:
  • Phone: 615-712-8073
  • Fax:
Mailing address:
  • Phone: 615-712-8073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: YERUSALEM LANIER
Title or Position: OWNER
Credential:
Phone: 765-274-3845