MEDICARE: MS. DAWN LANNETTE CARTER-BRISTOL PA-C

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	363A00000X	Physician Assistant	1653	TN

General Provider Information

NPI Number	:	1417107608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAWN LANNETTE CARTER-BRISTOL PA-C

Provider Business Mailing Address
First Line	:	1113 CROSS CREEK DR
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-4002
Country	:	US
Telephone Number	:	615-791-1368
Fax Number	:	615-791-1622

Provider Business Practice Location Address
First Line	:	1005 DR. D. B. TODD JR. BLVD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37208-3599
Country	:	US
Telephone Number	:	615-812-0937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	09/24/2008

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