Healthcare Provider Details

I. General information

NPI: 1225195712
Provider Name (Legal Business Name): SOUTHEASTERN EAR, NOSE & THROAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 HARDING PIKE SUITE 803
NASHVILLE TN
37205-2013
US

IV. Provider business mailing address

4230 HARDING PIKE SUITE 803
NASHVILLE TN
37205-2013
US

V. Phone/Fax

Practice location:
  • Phone: 615-386-9089
  • Fax: 615-386-2197
Mailing address:
  • Phone: 615-386-9089
  • Fax: 615-386-2197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE WHITE
Title or Position: ADMINISTRATIVE SECRETARY
Credential:
Phone: 615-386-9089