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General NPI Number Information
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NPI Number | 1497540314
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Entity Type | Organization
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Legal Business Name | FOUNDATION MEDICAL GROUP
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Dates
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Enumeration Date | 04/11/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 308 HARPETH HILLS DR
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City | FRANKLIN
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State | TN
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Zip | 37069-6205
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Country | US
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Telephone | 858-776-3538
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Fax |
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Provider Business Mailing Address
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Address Line | 1311 W MAIN ST
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City | FRANKLIN
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State | TN
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Zip | 37064-3300
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Country | US
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Telephone | 629-223-5392
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Fax | 615-599-6988
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Authorized Official
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Title or Position | OWNER
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Name | JEREMY KRIDER
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Credential | PA-C
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Telephone | 629-223-5392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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