Healthcare Provider Details

I. General information

NPI: 1952473431
Provider Name (Legal Business Name): PHILLIP L. BEAULIEU JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 25TH AVE N STE 203
NASHVILLE TN
37203-1593
US

IV. Provider business mailing address

PMB #382 5133 HARDING PIKE, B-10
NASHVILLE TN
37205-2891
US

V. Phone/Fax

Practice location:
  • Phone: 615-815-1560
  • Fax: 615-610-1199
Mailing address:
  • Phone: 615-815-1560
  • Fax: 615-610-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number45139
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number45139
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number45139
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number45139
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: