Healthcare Provider Details

I. General information

NPI: 1154391852
Provider Name (Legal Business Name): STEPHANIE E SPOTTSWOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 CHILDRENS WAY STE 1418
NASHVILLE TN
37232-9700
US

IV. Provider business mailing address

2200 CHILDRENS WAY STE 1418
NASHVILLE TN
37232-9700
US

V. Phone/Fax

Practice location:
  • Phone: 615-936-4943
  • Fax: 615-936-4949
Mailing address:
  • Phone: 615-936-4943
  • Fax: 615-936-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD19558
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberMD19558
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD19558
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: