Healthcare Provider Details

I. General information

NPI: 1154666451
Provider Name (Legal Business Name): THE VACCINATION CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7648 HIGHWAY 70 S SUITE 15
NASHVILLE TN
37221-1742
US

IV. Provider business mailing address

7648 HIGHWAY 70 S SUITE 15
NASHVILLE TN
37221-1742
US

V. Phone/Fax

Practice location:
  • Phone: 615-469-7413
  • Fax: 615-469-5935
Mailing address:
  • Phone: 615-469-7413
  • Fax: 615-469-5935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAYE J IVANOFF
Title or Position: SECRETARY
Credential: RN
Phone: 615-525-7618