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General NPI Number Information
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NPI Number | 1619903895
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Entity Type | Organization
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Legal Business Name | STONES RIVER PSYCHIATRIC GROUP PC
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 09/01/2011
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Provider Practice Location Address
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Address Line | 1024 N HIGHLAND AVE SUITE B
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City | MURFREESBORO
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State | TN
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Zip | 37130-2443
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Country | US
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Telephone | 615-893-8755
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Fax | 615-893-8732
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Provider Business Mailing Address
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Address Line | 1024 N HIGHLAND AVE SUITE B
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City | MURFREESBORO
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State | TN
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Zip | 37130-2443
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Country | US
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Telephone | 615-893-8755
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Fax | 615-893-8732
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Authorized Official
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Title or Position | OWNER
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Name | SHIPRA M PUTATUNDA
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Credential | MD
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Telephone | 615-893-8755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD0000025786
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License Number State | TN
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