MEDICARE: PRIVIA MEDICAL GROUP TENNESSEE LLC

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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1467224667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIVIA MEDICAL GROUP TENNESSEE LLC

Provider Business Mailing Address
First Line	:	3715 NORTHSIDE PKWY NW STE 550
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2886
Country	:	US
Telephone Number	:	770-312-5226
Fax Number	:

Provider Business Practice Location Address
First Line	:	6746 CHARLOTTE PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-4204
Country	:	US
Telephone Number	:	571-366-8850
Fax Number	:

Authorized Official
Title or Position	:	ASSOCIATE DIRECTOR
Name	:	MARY L ROLLER
Credential	:
Telephone Number	:	707-312-5226

Provider Enumeration Date	:	10/23/2023
Last Update Date	:	10/23/2023

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