Healthcare Provider Details

I. General information

NPI: 1497036198
Provider Name (Legal Business Name): BALSAM MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 W ADAMS ST
WOODBURY TN
37190-1622
US

IV. Provider business mailing address

PO BOX 24
WOODBURY TN
37190-0024
US

V. Phone/Fax

Practice location:
  • Phone: 615-962-3675
  • Fax:
Mailing address:
  • Phone: 615-962-3675
  • Fax: 615-246-4294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAULA TODD
Title or Position: NURSE PRACTITIONER
Credential: FNP
Phone: 615-962-3675