Healthcare Provider Details

I. General information

NPI: 1972674968
Provider Name (Legal Business Name): CASEY BURGDORF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 PATTERSON ST
NASHVILLE TN
37203-1562
US

IV. Provider business mailing address

2400 PATTERSON STREET SUITE 311
NASHVILLE TN
37203-6533
US

V. Phone/Fax

Practice location:
  • Phone: 615-342-6830
  • Fax: 615-342-8636
Mailing address:
  • Phone: 615-342-6830
  • Fax: 615-342-8636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19161
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: