Healthcare Provider Details

I. General information

NPI: 1336154202
Provider Name (Legal Business Name): SKYLINE MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 DICKERSON PIKE SUITE G-30
NASHVILLE TN
37207-2519
US

IV. Provider business mailing address

3443 DICKERSON PIKE SUITE G-30
NASHVILLE TN
37207-2519
US

V. Phone/Fax

Practice location:
  • Phone: 615-234-6390
  • Fax: 615-234-6393
Mailing address:
  • Phone: 615-234-6390
  • Fax: 615-234-6393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JEFF RYDBURG
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-373-7415