Healthcare Provider Details

I. General information

NPI: 1255738043
Provider Name (Legal Business Name): CONWAY THERAPEUTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2014
Last Update Date: 11/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 WALLACE RD SUITE103
NASHVILLE TN
37211-4893
US

IV. Provider business mailing address

330 WALLACE RD SUITE103
NASHVILLE TN
37211-4893
US

V. Phone/Fax

Practice location:
  • Phone: 615-832-5530
  • Fax: 615-832-5713
Mailing address:
  • Phone: 615-832-5530
  • Fax: 615-832-5713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberMD0000016892
License Number StateTN

VIII. Authorized Official

Name: ROBERT W. HERRING JR.
Title or Position: OWNER
Credential: M.D.
Phone: 615-832-5530