1740288810 NPI number — DR. FREDERICK OLATUNJI JUNARD MD

Table of content: ELIZAVETA EGOROVA LMFT (NPI 1861107260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740288810 NPI number — DR. FREDERICK OLATUNJI JUNARD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUNARD
Provider First Name:
FREDERICK
Provider Middle Name:
OLATUNJI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1740288810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/15/2006
NPI Reactivation Date:
03/27/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 110284
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-732-0228
Provider Business Mailing Address Fax Number:
615-732-0231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
393 WALLACE ROAD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-732-0228
Provider Business Practice Location Address Fax Number:
615-732-0231
Provider Enumeration Date:
07/12/2005

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: 207R00000X , with the licence number:  H35033 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 31801 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2026 www.npivalidator.com