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General NPI Number Information
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NPI Number | 1366620643
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL MEDICINE, PLLC
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Dates
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Enumeration Date | 02/08/2008
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 401 TYSON AVE
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City | PARIS
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State | TN
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Zip | 38242-4821
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Country | US
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Telephone | 731-642-4422
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Fax | 731-642-0068
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Provider Business Mailing Address
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Address Line | PO BOX 731
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City | PARIS
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State | TN
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Zip | 38242-0731
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Country | US
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Telephone | 731-642-4422
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Fax | 731-642-0068
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Authorized Official
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Title or Position | OWNER
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Name | DONALD GOLD
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Credential |
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Telephone | 731-642-4422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 9580
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License Number State | TN
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