Healthcare Provider Details

I. General information

NPI: 1033850052
Provider Name (Legal Business Name): ALLAN JOEL MEJIA PORTILLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
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

1912B 9TH AVE N
NASHVILLE TN
37208-1526
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-6611
  • Fax:
Mailing address:
  • Phone: 346-234-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number74953
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: