=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235995093
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYRUS GRANT NABAVI PA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2024
-----------------------------------------------------
Last Update Date | 07/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 702 S CUMBERLAND ST
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37087-4110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-444-2121
-----------------------------------------------------
Fax | 615-547-6474
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 702 S CUMBERLAND ST
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37087-4110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-444-2121
-----------------------------------------------------
Fax | 615-547-6474
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 6233
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------