Healthcare Provider Details

I. General information

NPI: 1750136628
Provider Name (Legal Business Name): PRAJWAL HEGDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MEDICAL CENTER DR STE 3930
NASHVILLE TN
37232-0011
US

IV. Provider business mailing address

324 SOMERLED WAY
WAXHAW NC
28173-0067
US

V. Phone/Fax

Practice location:
  • Phone: 513-910-8481
  • Fax:
Mailing address:
  • Phone: 513-910-8481
  • 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: