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NPI Code Detail

MEDICARE: MOLLIE PERRY RD

MEDICARE: MOLLIE PERRY RD
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
1133V00000XRegistered Dietitian2605TN

General Provider Information

NPI Number : 1508325168
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLIE PERRY RD
Provider Business Mailing Address
First Line : 112 BROOKFIELD AVE
Second Line :
City : NASHVILLE
State : TN
Zip : 37205-4402
Country : US
Telephone Number : 615-347-7930
Fax Number :
Provider Business Practice Location Address
First Line : 2002 EASTLAND AVE STE 101
Second Line :
City : NASHVILLE
State : TN
Zip : 37206-1705
Country : US
Telephone Number : 615-347-7930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2019
Last Update Date : 03/13/2019

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Directions to “ MOLLIE PERRY RD” Practice Location

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