MEDICARE: HARDIE V SORRELS III M.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	207R00000X	Internal Medicine Physician	18079	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942314075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARDIE V SORRELS III M.D.

Provider Business Mailing Address
First Line	:	222 22ND AVE N
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1870
Country	:	US
Telephone Number	:	629-255-3486
Fax Number	:

Provider Business Practice Location Address
First Line	:	715B CASTLE HEIGHTS CT
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-2646
Country	:	US
Telephone Number	:	629-255-2274
Fax Number	:	629-255-4250

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	08/08/2022

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