MEDICARE: DR. RENNEE NAGRA DHILLON MD

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	207Q00000X	Family Medicine Physician	MD038730	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
2	4092415	OTHER	TN	BLUE CROSS BLUE SHIELD TN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952396921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENNEE NAGRA DHILLON MD

Provider Business Mailing Address
First Line	:	1195 OLD HICKORY BLVD
Second Line	:	SUITE 103
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4239
Country	:	US
Telephone Number	:	615-818-9888
Fax Number	:	615-891-5021

Provider Business Practice Location Address
First Line	:	5073 MAIN ST
Second Line	:	SUITE 100
City	:	SPRING HILL
State	:	TN
Zip	:	37174-2737
Country	:	US
Telephone Number	:	615-302-0885
Fax Number	:	615-891-5003

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	09/18/2014

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