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General NPI Number Information
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NPI Number | 1003042995
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Entity Type | Organization
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Legal Business Name | 4UMD, LLC
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Dates
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Enumeration Date | 06/05/2009
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Last Update Date | 07/13/2012
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Provider Practice Location Address
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Address Line | 555 CHURCH STREET EAST SUITE 202
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City | BRENTWOOD
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State | TN
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Zip | 37027-4896
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Country | US
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Telephone | 615-376-4863
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Fax | 615-807-4990
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Provider Business Mailing Address
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Address Line | 555 CHURCH STREET EAST SUITE 202
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City | BRENTWOOD
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State | TN
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Zip | 37027-4896
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Country | US
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Telephone | 615-376-4863
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Fax | 615-807-4990
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Authorized Official
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Title or Position | CHIEF MANAGER
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Name | MR. WILLIAM M KOTTAS JR.
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Credential |
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Telephone | 615-477-6542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246X00000X
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Taxonomy Name | Cardiovascular Specialist/Technologist
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License Number | APPLIED FOR
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License Number State | TN
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