Healthcare Provider Details

I. General information

NPI: 1932511680
Provider Name (Legal Business Name): HAROLD EMBRACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 DR D. B. TODD BLVD.
NASHVILLE TN
37208-3501
US

IV. Provider business mailing address

1005 D. B. TODD BLVD.
NASHVILLE TN
37208-3501
US

V. Phone/Fax

Practice location:
  • Phone: 347-228-0025
  • Fax:
Mailing address:
  • Phone: 347-228-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number58300
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: