1477929917 NPI number — AMY WHITE DILLER

Table of content: AMY WHITE DILLER (NPI 1477929917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477929917 NPI number — AMY WHITE DILLER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DILLER
Provider First Name:
AMY
Provider Middle Name:
WHITE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITE
Provider Other First Name:
AMY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477929917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 S PERIMETER PARK DR
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37211-4143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-295-2176
Provider Business Mailing Address Fax Number:
615-295-2645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1630 S CHURCH ST
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37130-5551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-295-2176
Provider Business Practice Location Address Fax Number:
615-295-2645
Provider Enumeration Date:
08/19/2015

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: 1041C0700X , with the licence number:  4362 , 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: 1534575 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com