Healthcare Provider Details
I. General information
NPI: 1225682198
Provider Name (Legal Business Name): TENNESSEE CENTER FOR BRAIN HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/30/2019
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2900 FELICIA ST STE 103
NASHVILLE TN
37209-4043
US
IV. Provider business mailing address
9005 FALLSWOOD LN
BRENTWOOD TN
37027-8679
US
V. Phone/Fax
- Phone: 615-450-6758
- Fax: 908-282-3384
- Phone: 615-482-5535
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2081P0301X |
| Taxonomy | Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
SRAVANI
VENKATA ANJANA
MEHTA
Title or Position: CO-FOUNDER
Credential: MD
Phone: 615-482-5535