=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255738043
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONWAY THERAPEUTICS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2014
-----------------------------------------------------
Last Update Date | 11/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 WALLACE RD SUITE103
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37211-4893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-832-5530
-----------------------------------------------------
Fax | 615-832-5713
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 WALLACE RD SUITE103
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37211-4893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-832-5530
-----------------------------------------------------
Fax | 615-832-5713
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBERT W. HERRING JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 615-832-5530
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | MD0000016892
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------