Healthcare Provider Details

I. General information

NPI: 1982273637
Provider Name (Legal Business Name): PBH PROFESSIONAL GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 WESTWOOD DR STE 100
NASHVILLE TN
37204-2709
US

IV. Provider business mailing address

103 POWELL CT STE 100
BRENTWOOD TN
37027-5050
US

V. Phone/Fax

Practice location:
  • Phone: 629-899-6072
  • Fax:
Mailing address:
  • Phone: 615-567-7253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: FLORA F. SADRI-AZARBAYEJANI
Title or Position: PRESIDENT, SECRETARY, DIRECTOR
Credential: D.O.
Phone: 413-498-5563