Healthcare Provider Details

I. General information

NPI: 1740279660
Provider Name (Legal Business Name): STEPHEN E GRINDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 CHURCH ST SUITE 603
NASHVILLE TN
37203-2012
US

IV. Provider business mailing address

3443 DICKERSON PIKE SUITE 200
NASHVILLE TN
37207-2539
US

V. Phone/Fax

Practice location:
  • Phone: 615-284-5755
  • Fax: 615-284-5759
Mailing address:
  • Phone: 615-860-5773
  • Fax: 615-860-1542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD0000014954
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number27981
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: