MEDICARE: TENNESSEE CENTER FOR BRAIN HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P0301X	Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225682198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESSEE CENTER FOR BRAIN HEALTH

Provider Business Mailing Address
First Line	:	9005 FALLSWOOD LN
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-8679
Country	:	US
Telephone Number	:	615-482-5535
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 FELICIA ST STE 103
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-4043
Country	:	US
Telephone Number	:	615-450-6758
Fax Number	:	908-282-3384

Authorized Official
Title or Position	:	CO-FOUNDER
Name	:	DR. SRAVANI VENKATA ANJANA MEHTA
Credential	:	MD
Telephone Number	:	615-482-5535

Provider Enumeration Date	:	07/30/2019
Last Update Date	:	07/30/2019

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