=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417920893
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARCEL YEMBA ELUHU M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2006
-----------------------------------------------------
Last Update Date | 09/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 317 18TH AVE NORTH STE 101
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-320-7151
-----------------------------------------------------
Fax | 612-320-5976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 317 18TH AVE N STE 101
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-320-7151
-----------------------------------------------------
Fax | 612-320-5976
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | MD17420
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------