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General NPI Number Information
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NPI Number | 1770626319
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Entity Type | Organization
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Legal Business Name | SUSAN DOUGLAS MD LLC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 02/18/2013
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Provider Practice Location Address
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Address Line | 5115 MARYLAND WAY SUITE 119
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City | BRENTWOOD
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State | TN
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Zip | 37027-1200
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Country | US
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Telephone | 615-377-0722
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Fax | 615-377-0724
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Provider Business Mailing Address
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Address Line | 709 WAYSIDE CT
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City | FRANKLIN
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State | TN
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Zip | 37069-8105
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Country | US
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Telephone | 615-418-3913
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Fax | 615-377-0724
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Authorized Official
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Title or Position | OWNER MEMBER
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Name | DR. SUSAN S DOUGLAS
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Credential | MD
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Telephone | 615-377-0722
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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 | 37902
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License Number State | TN
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