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General NPI Number Information
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NPI Number | 1962317602
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Entity Type | Organization
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Legal Business Name | PRIVIA MEDICAL GROUP TENNESSEE LLC
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Dates
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Enumeration Date | 08/17/2026
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Last Update Date | 08/17/2026
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Provider Practice Location Address
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Address Line | 1272 GARRISON DR
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City | MURFREESBORO
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State | TN
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Zip | 37129-2570
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Country | US
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Telephone | 770-312-5226
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Fax |
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Provider Business Mailing Address
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Address Line | 3715 NORTHSIDE PARKWAY, BUILDING 100 STE 550
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City | ATLANTA
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State | GA
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Zip | 30327
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Country | US
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Telephone | 770-312-5226
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Fax |
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Authorized Official
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Title or Position | SR DIRECTOR PROVIDER ENROLLMENT
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Name | MARY L ROLLER
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Credential |
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Telephone | 770-312-5226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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