Healthcare Provider Details

I. General information

NPI: 1699080994
Provider Name (Legal Business Name): EINAR THOR HAFBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 07/21/2022
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 CHILDRENS WAY # 10109
NASHVILLE TN
37232-0005
US

IV. Provider business mailing address

2200 CHILDREN'S WAY DOT 10109
NASHVILLE TN
27232
US

V. Phone/Fax

Practice location:
  • Phone: 615-343-5323
  • Fax:
Mailing address:
  • Phone: 615-343-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number55636
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2080T0004X
TaxonomyPediatric Transplant Hepatology Physician
License Number55636
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: