Healthcare Provider Details

I. General information

NPI: 1821296088
Provider Name (Legal Business Name): SOUTHCREST CLINIC, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3413 NOLENSVILLE PIKE SUITE A
NASHVILLE TN
37211-2911
US

IV. Provider business mailing address

3413 NOLENSVILLE PIKE SUITE A
NASHVILLE TN
37211-2911
US

V. Phone/Fax

Practice location:
  • Phone: 615-333-8383
  • Fax: 615-333-1660
Mailing address:
  • Phone: 615-333-8383
  • Fax: 615-333-1660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number38730
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberMD42852
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD42852
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD 38730
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD42852
License Number StateTN
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD 11290
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberMD 11290
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD11290
License Number StateTN
# 9
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6193390001
License Number StateTN

VIII. Authorized Official

Name: DR. KAY SON
Title or Position: PRESIDENT
Credential: M. D.
Phone: 615-333-8383