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General NPI Number Information
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NPI Number | 1619404126
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Entity Type | Individual
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Provider Name | MR. DOZIE MATTHEW NNAMAH
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Gender | Male
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Dates
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Enumeration Date | 05/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2572A MURFREESBORO PIKE STE D
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City | NASHVILLE
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State | TN
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Zip | 37217-3577
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Country | US
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Telephone | 615-499-4234
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Fax | 615-835-3360
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Provider Business Mailing Address
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Address Line | 2572A MURFREESBORO PIKE STE D
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City | NASHVILLE
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State | TN
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Zip | 37217-3577
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Country | US
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Telephone | 615-499-4234
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Fax | 615-835-3360
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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 | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | L000000017827
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License Number State | TN
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