Healthcare Provider Details

I. General information

NPI: 1366484032
Provider Name (Legal Business Name): METRO CENTER HEALTH CARE GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 FRENCH LANDING DR
NASHVILLE TN
37228-1511
US

IV. Provider business mailing address

131 FRENCH LANDING DR
NASHVILLE TN
37228-1511
US

V. Phone/Fax

Practice location:
  • Phone: 615-254-9981
  • Fax: 615-254-9747
Mailing address:
  • Phone: 615-254-9981
  • Fax: 615-254-9747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number15942
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MELVIN W LIGHTFORD
Title or Position: PRINCIPAL
Credential: MD
Phone: 615-254-9981