MEDICARE: ADDICTION CENTER OF NASHVILLE 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	207RA0401X	Addiction Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1649764911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDICTION CENTER OF NASHVILLE LLC

Provider Business Mailing Address
First Line	:	1300 HATCHER LN STE 5
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3554
Country	:	US
Telephone Number	:	931-548-3177
Fax Number	:	931-548-3177

Provider Business Practice Location Address
First Line	:	1300 HATCHER LN STE 5
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3554
Country	:	US
Telephone Number	:	931-548-3177
Fax Number	:	931-548-3177

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHAUN CARRIGAN
Credential	:
Telephone Number	:	931-548-3177

Provider Enumeration Date	:	06/19/2018
Last Update Date	:	10/17/2019

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