MEDICARE: CHEATHAM DAM INPATIENT SERVICES PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	208M00000X	Hospitalist Physician	TN

General Provider Information

NPI Number	:	1447506167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHEATHAM DAM INPATIENT SERVICES PLLC

Provider Business Mailing Address
First Line	:	3114 CROASDAILE DR STE 200
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-2508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 N MAIN ST
Second Line	:
City	:	ASHLAND CITY
State	:	TN
Zip	:	37015-1347
Country	:	US
Telephone Number	:	615-792-3030
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KATHY KONDAS
Credential	:
Telephone Number	:	973-251-1132

Provider Enumeration Date	:	07/31/2012
Last Update Date	:	02/26/2021

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