=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588087563
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLVIEW, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2014
-----------------------------------------------------
Last Update Date | 01/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 127 FRANKLIN ROAD SUITE 310
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-915-3887
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 127 FRANKLIN ROAD SUITE 310
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-915-3887
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | CHRISTOPHER R KUZNIAK
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 615-915-3887
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------