Healthcare Provider Details

I. General information

NPI: 1851117840
Provider Name (Legal Business Name): TERESA LYTTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA CAMPBELL

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 GLEN ECHO RD STE 111
NASHVILLE TN
37215-2857
US

IV. Provider business mailing address

PO BOX 936535
ATLANTA GA
31193-6535
US

V. Phone/Fax

Practice location:
  • Phone: 615-657-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberLPN0000050440
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: