1225682198 NPI number — TENNESSEE CENTER FOR BRAIN HEALTH

Table of content: (NPI 1225682198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225682198 NPI number — TENNESSEE CENTER FOR BRAIN HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENNESSEE CENTER FOR BRAIN HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1225682198
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9005 FALLSWOOD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-8679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-482-5535
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 FELICIA ST STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37209-4043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-450-6758
Provider Business Practice Location Address Fax Number:
908-282-3384
Provider Enumeration Date:
07/30/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MEHTA
Authorized Official First Name:
SRAVANI
Authorized Official Middle Name:
VENKATA ANJANA
Authorized Official Title or Position:
CO-FOUNDER
Authorized Official Telephone Number:
615-482-5535

Provider Taxonomy Codes

  • Taxonomy code: 2081P0301X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q050091 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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