MEDICARE: THE DEMESSO GROUP 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	103TR0400X	Rehabilitation Psychologist

General Provider Information

NPI Number	:	1740485945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DEMESSO GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 282302
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37228-8514
Country	:	US
Telephone Number	:	615-327-0728
Fax Number	:	615-327-0282

Provider Business Practice Location Address
First Line	:	1514 UNDERWOOD ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37208
Country	:	US
Telephone Number	:	615-327-0728
Fax Number	:	615-327-0282

Authorized Official
Title or Position	:	CEO
Name	:	MR. D B FULLER
Credential	:
Telephone Number	:	615-327-0728

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	08/22/2020

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