1194834614 NPI number — ERNEST ALEXANDER MOSLEY JR. PT

Table of content: ERNEST ALEXANDER MOSLEY JR. PT (NPI 1194834614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194834614 NPI number — ERNEST ALEXANDER MOSLEY JR. PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSLEY
Provider First Name:
ERNEST
Provider Middle Name:
ALEXANDER
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194834614
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2140 LOUDENSLAGER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THOMPSONS STATION
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37179-5312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-591-9671
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 PENN WARREN DR
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
BRENTWOOD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37027-5047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-377-8070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4327 . This is a "LICENSE #" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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