Healthcare Provider Details

I. General information

NPI: 1215133400
Provider Name (Legal Business Name): BARRY T DORITY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 NORTHCREST DR
SPRINGFIELD TN
37172-3972
US

IV. Provider business mailing address

3125 SANDY SPRINGS RD
PLEASANT VIEW TN
37146-2812
US

V. Phone/Fax

Practice location:
  • Phone: 615-384-1571
  • Fax:
Mailing address:
  • Phone: 615-384-1571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12120
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: