Healthcare Provider Details

I. General information

NPI: 1700635836
Provider Name (Legal Business Name): PRAVEEN VIMALATHAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 21ST AVENUE SOUTH MEDICAL CENTER NORTH SUITE CCC-4312
NASHVILLE TN
37232
US

IV. Provider business mailing address

1161 21ST AVENUE SOUTH MEDICAL CENTER NORTH SUITE CCC-4312
NASHVILLE TN
37232
US

V. Phone/Fax

Practice location:
  • Phone: 615-343-6642
  • Fax:
Mailing address:
  • Phone:
  • 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: