Healthcare Provider Details

I. General information

NPI: 1679549851
Provider Name (Legal Business Name): MICHAEL C THORNTON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CITY BLVD STE 300
NASHVILLE TN
37209-2560
US

IV. Provider business mailing address

PO BOX 306556
NASHVILLE TN
37230-6556
US

V. Phone/Fax

Practice location:
  • Phone: 615-329-6600
  • Fax: 615-321-6226
Mailing address:
  • Phone: 615-329-2294
  • Fax: 615-695-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.0003671
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5783
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: