Healthcare Provider Details

I. General information

NPI: 1720466741
Provider Name (Legal Business Name): DAVID WALLACE NEBLETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6746 CHARLOTTE PIKE
NASHVILLE TN
37209-4204
US

IV. Provider business mailing address

6746 CHARLOTTE PIKE
NASHVILLE TN
37209-4204
US

V. Phone/Fax

Practice location:
  • Phone: 629-203-7585
  • Fax: 629-203-7857
Mailing address:
  • Phone: 629-203-7585
  • Fax: 629-203-7857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number58132
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: