Healthcare Provider Details

I. General information

NPI: 1487733895
Provider Name (Legal Business Name): KEVIN B SANDERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 TVC
NASHVILLE TN
37232-0001
US

IV. Provider business mailing address

3601 TVC
NASHVILLE TN
37232-0001
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-3000
  • Fax:
Mailing address:
  • Phone: 615-322-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD44855
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: