MEDICARE: DR. BAYARD DODGE REA PSY.D

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	103TC0700X	Clinical Psychologist	0000002482	TN
2	103TF0000X	Family Psychologist	0000002482	TN
3	103TP2701X	Group Psychotherapy Psychologist	0000002482	TN

General Provider Information

NPI Number	:	1780881474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BAYARD DODGE REA PSY.D

Provider Business Mailing Address
First Line	:	2919 BERRY HILL DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-3126
Country	:	US
Telephone Number	:	615-577-0995
Fax Number	:	614-577-0997

Provider Business Practice Location Address
First Line	:	2919 BERRY HILL DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-3126
Country	:	US
Telephone Number	:	615-577-0995
Fax Number	:	614-577-0997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	07/24/2007

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