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General NPI Number Information
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NPI Number | 1821426347
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Entity Type | Organization
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Legal Business Name | OLD HICKORY LANE EMERGENCY PHYSICIANS PLLC
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Dates
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Enumeration Date | 10/18/2013
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 355 NEW SHCKL IS RD
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2479
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Country | US
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Telephone | 615-338-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 13737 NOEL RD STE 1600
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City | DALLAS
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State | TX
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Zip | 75240-1331
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Country | US
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Telephone | 954-838-2371
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | KATHLEEN KONDAS
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Credential |
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Telephone | 973-251-1132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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