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General NPI Number Information
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NPI Number | 1386933166
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Entity Type | Organization
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Legal Business Name | TENNESSEE PEDIATRIC & ADOLESCENT CENTER
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 435 N CEDAR AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-5401
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Country | US
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Telephone | 931-526-6100
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Fax | 931-526-6002
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Provider Business Mailing Address
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Address Line | 435 N CEDAR AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-5401
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Country | US
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Telephone | 931-526-6100
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Fax | 931-526-6002
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | DR. SATYA NARAYAN CHAKRABARTY
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Credential | MD
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Telephone | 931-526-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | MD44069
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN0000148368
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN15014
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | MD28171
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License Number State | TN
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