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General NPI Number Information
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NPI Number | 1861484693
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Entity Type | Individual
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Provider Name | JULIA MARIE DEBOLD PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 508 DAVIDSON ST #204
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City | NASHVILLE
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State | TN
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Zip | 37213-1414
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Country | US
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Telephone | 615-730-8051
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 ROSA L PARKS BLVD UNIT 429
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City | NASHVILLE
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State | TN
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Zip | 37208-2502
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Country | US
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Telephone | 615-499-8934
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1119
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License Number State | TN
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