Healthcare Provider Details

I. General information

NPI: 1003196429
Provider Name (Legal Business Name): SCOTTIE ABRAHAM BUSSELL MD,MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 DR DB TODD JR BLVD
NASHVILLE TN
37208-3501
US

IV. Provider business mailing address

1005 DR DB TODD JR BLVD
NASHVILLE TN
37208-3501
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-6782
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number17751
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: