Healthcare Provider Details

I. General information

NPI: 1528321163
Provider Name (Legal Business Name): MARGARET MOORE LAXTON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGARET JOAN MOORE P.A.

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 21ST AVE S SUITE 6000 MEDICAL CENTER EAST - NORTH TOWER
NASHVILLE TN
37232-8300
US

IV. Provider business mailing address

3841 GREEN HILLS VILLAGE DR STE 200
NASHVILLE TN
37215-2691
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2165
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: