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General NPI Number Information
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NPI Number | 1083941512
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Entity Type | Organization
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Legal Business Name | CONCORD INFECTIOUS DISEASE ASSOCIATES, PC
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 1419 W BADDOUR PKWY
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City | LEBANON
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State | TN
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Zip | 37087-2513
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Country | US
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Telephone | 615-420-5390
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Fax | 615-549-1532
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Provider Business Mailing Address
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Address Line | PO BOX 1906
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City | MOUNT JULIET
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State | TN
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Zip | 37121-1906
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Country | US
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Telephone | 615-420-5390
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Fax | 615-549-1532
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HAROON N KHAN
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Credential | MD
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Telephone | 615-420-5390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 41277
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License Number State | TN
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