1205999844 NPI number — AMANDA J EDWARDS AUD

Table of content: AMANDA J EDWARDS AUD (NPI 1205999844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205999844 NPI number — AMANDA J EDWARDS AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS
Provider First Name:
AMANDA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

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:
1205999844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3841 GREEN HILLS VILLAGE DR STE 200
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:
37215-2691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-936-2000
Provider Business Mailing Address Fax Number:
615-936-5088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 21ST AVE S
Provider Second Line Business Practice Location Address:
SUITE 9302
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37232-8025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-322-4327
Provider Business Practice Location Address Fax Number:
615-936-5088
Provider Enumeration Date:
12/18/2006

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: 231H00000X , with the licence number:  AY1681 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 1395 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 613258400 . This is a "OWCP-DOL FECA AND DEEOIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9068084 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4165989 . This is a "BCBS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7100033990 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01161027 . This is a "AMERIGROUP TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 10028887 . This is a "SIGNATURE HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 39671221 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5687960 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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