Healthcare Provider Details

I. General information

NPI: 1326085747
Provider Name (Legal Business Name): METROPOLITAN INTERDENOMINATIONAL CHURCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 9TH AVE N
NASHVILLE TN
37208-2552
US

IV. Provider business mailing address

PO BOX 280779
NASHVILLE TN
37228-0779
US

V. Phone/Fax

Practice location:
  • Phone: 615-277-0615
  • Fax: 615-321-9793
Mailing address:
  • Phone: 615-321-9791
  • Fax: 615-321-9793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRY TERRELL
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 615-321-9791