Healthcare Provider Details

I. General information

NPI: 1427346147
Provider Name (Legal Business Name): DAVID A SACK MD TN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6107 PINEWOOD RD
NUNNELLY TN
37137-2523
US

IV. Provider business mailing address

PO BOX 670521
DALLAS TX
75267-0521
US

V. Phone/Fax

Practice location:
  • Phone: 800-849-5969
  • Fax: 931-729-9632
Mailing address:
  • Phone: 615-567-7282
  • Fax: 615-807-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN0000007899
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN0000017055
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0000036454
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN0000015776
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD21339
License Number StateTN
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0000021860
License Number StateTN

VIII. Authorized Official

Name: MRS. CHERYL MAPLESDEN
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential: CPC, CHC, CHPC
Phone: 615-510-3078