Healthcare Provider Details

I. General information

NPI: 1427477470
Provider Name (Legal Business Name): MARY-ELLEN ADELE EDMISTON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 PATTERSON ST
NASHVILLE TN
37203-2926
US

IV. Provider business mailing address

1718 PATTERSON ST
NASHVILLE TN
37203-2926
US

V. Phone/Fax

Practice location:
  • Phone: 615-963-4800
  • Fax: 813-871-8184
Mailing address:
  • Phone: 615-963-4800
  • Fax: 813-871-8184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number5916
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: