Healthcare Provider Details

I. General information

NPI: 1376713701
Provider Name (Legal Business Name): TENNESSEE PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 WILLIAMSBURGH WEST CT
NASHVILLE TN
37221-2609
US

IV. Provider business mailing address

PO BOX 331283
NASHVILLE TN
37203
US

V. Phone/Fax

Practice location:
  • Phone: 615-369-6500
  • Fax:
Mailing address:
  • Phone: 615-369-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number0570
License Number StateTN

VIII. Authorized Official

Name: RICHARD ALAN BREEDEN
Title or Position: OWNER
Credential: DPM
Phone: 615-369-6500