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General NPI Number Information
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NPI Number | 1972080257
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Entity Type | Organization
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Legal Business Name | RIGHT TRACK MEDICAL GROUP, INC
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 9035 E SANDIDGE RD STE 201
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-3563
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Country | US
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Telephone | 662-234-7601
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Fax | 662-234-8531
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Provider Business Mailing Address
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Address Line | PO BOX 306600
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City | NASHVILLE
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State | TN
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Zip | 37230-6600
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Country | US
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Telephone | 662-234-7601
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Fax | 662-234-8531
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | KIMBERLY GLAVESKAS
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Credential |
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Telephone | 214-550-7536
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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 | 21831
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License Number State | MS
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