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General NPI Number Information
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NPI Number | 1467545541
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Entity Type | Individual
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Provider Name | KENNETH W. ANDERSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 03/18/2017
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Provider Practice Location Address
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Address Line | 501 PARK AVE SUITE C
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City | LEBANON
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State | TN
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Zip | 37087-1706
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Country | US
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Telephone | 615-444-4070
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Fax | 615-444-4099
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | LEBANON
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State | TN
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Zip | 37088-0190
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Country | US
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Telephone | 615-444-4070
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Fax | 615-444-4099
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD012869
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License Number State | TN
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