Healthcare Provider Details

I. General information

NPI: 1538726914
Provider Name (Legal Business Name): ARETHA DOUGLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 HART LN
NASHVILLE TN
37216-2007
US

IV. Provider business mailing address

717 HART LN
NASHVILLE TN
37216-2007
US

V. Phone/Fax

Practice location:
  • Phone: 615-460-4290
  • Fax:
Mailing address:
  • Phone: 615-460-4290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: