Healthcare Provider Details

I. General information

NPI: 1275971798
Provider Name (Legal Business Name): MARY GERGES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 04/10/2017
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

1211 BELL RD APT 198
ANTIOCH TN
37013-3797
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-6611
  • Fax:
Mailing address:
  • Phone: 615-710-2272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number54860
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: