Healthcare Provider Details

I. General information

NPI: 1982996211
Provider Name (Legal Business Name): OPHTHALMOLOGY MANAGEMENT GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 STATE ST
NASHVILLE TN
37203-2206
US

IV. Provider business mailing address

1800 STATE ST
NASHVILLE TN
37203-2206
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-4015
  • Fax: 615-327-4080
Mailing address:
  • Phone: 615-327-4015
  • Fax: 615-327-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4533
License Number StateTN

VIII. Authorized Official

Name: MR. CHRIS K MCWHORTER
Title or Position: OWNER
Credential:
Phone: 615-327-4015