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General NPI Number Information
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NPI Number | 1548565245
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Entity Type | Organization
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Legal Business Name | MID SOUTH ANESTHESIA PC
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Dates
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Enumeration Date | 01/11/2011
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 322 22ND AVE N
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City | NASHVILLE
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State | TN
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Zip | 37203-1842
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Country | US
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Telephone | 615-444-2320
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Fax | 615-547-9845
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Provider Business Mailing Address
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Address Line | PO BOX 5000
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City | LEBANON
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State | TN
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Zip | 37088-5000
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Country | US
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Telephone | 615-444-2320
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Fax | 615-547-9845
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Authorized Official
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Title or Position | PRES
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Name | RICHARD ALAN DAVENPORT SR.
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Credential | CRNA, MS, APN
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Telephone | 615-444-2320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R0000058326
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License Number State | TN
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