Healthcare Provider Details

I. General information

NPI: 1104031053
Provider Name (Legal Business Name): KYLE MANNION M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER EAST SOUTH TOWER 1215 21ST AVENUE SOUTH, SUITE 7209
NASHVILLE TN
37232-8605
US

IV. Provider business mailing address

3841 GREEN HILLS VILLAGE DR STE 200
NASHVILLE TN
37215-2691
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-6180
  • Fax: 615-936-2887
Mailing address:
  • Phone: 615-936-2000
  • Fax: 615-936-2887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number236177
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberMD42138
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD0000042138
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: