Healthcare Provider Details

I. General information

NPI: 1265847040
Provider Name (Legal Business Name): MITCHEL SAUVAGEAU D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 09/29/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 HARDING PIKE STE 400
NASHVILLE TN
37205-4900
US

IV. Provider business mailing address

3024 BUSINESS PARK CIR
GOODLETTSVILLE TN
37072-3132
US

V. Phone/Fax

Practice location:
  • Phone: 615-386-9089
  • Fax: 615-386-2399
Mailing address:
  • Phone: 615-239-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number3681
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number5101021207
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: