Healthcare Provider Details

I. General information

NPI: 1801538632
Provider Name (Legal Business Name): EVAN TAYLOR MERCER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 THOMPSON LN STE 20400
NASHVILLE TN
37204-4600
US

IV. Provider business mailing address

3000 VANDERBILT PL APT 335
NASHVILLE TN
37212-2538
US

V. Phone/Fax

Practice location:
  • Phone: 615-936-2187
  • Fax: 615-936-6666
Mailing address:
  • Phone: 404-713-0675
  • 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: