Healthcare Provider Details

I. General information

NPI: 1942252648
Provider Name (Legal Business Name): TERRACE PEDIATRIC GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 21ST AVE N
NASHVILLE TN
37203-1848
US

IV. Provider business mailing address

342 21ST AVE N
NASHVILLE TN
37203-1848
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-9371
  • Fax: 615-329-6652
Mailing address:
  • Phone: 615-327-9371
  • Fax: 615-329-6652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6169
License Number StateTN

VIII. Authorized Official

Name: JAMES S PRICE
Title or Position: PARTNER
Credential: MD
Phone: 615-327-9371