Healthcare Provider Details

I. General information

NPI: 1225545353
Provider Name (Legal Business Name): MARY CAITLIN MEDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 BELMONT BLVD
NASHVILLE TN
37212-3758
US

IV. Provider business mailing address

217 GARNER ST
SPRINGFIELD TN
37172-2023
US

V. Phone/Fax

Practice location:
  • Phone: 615-460-8122
  • Fax:
Mailing address:
  • Phone: 502-415-8230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: