1659990851 NPI number — ROBERT WALLACE CORTY MD,PHD

Table of content: ROBERT WALLACE CORTY MD,PHD (NPI 1659990851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659990851 NPI number — ROBERT WALLACE CORTY MD,PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORTY
Provider First Name:
ROBERT
Provider Middle Name:
WALLACE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD,PHD
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:
1659990851
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2025
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 SUITE 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:
37232-5356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-322-1900
Provider Business Mailing Address Fax Number:
615-343-3813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 MEDICAL CENTER DR STE 2501
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:
37232-5356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-322-1900
Provider Business Practice Location Address Fax Number:
615-343-3813
Provider Enumeration Date:
04/09/2020

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:  66504 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246ZG1000X , with the licence number: 66504 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X , with the licence number: 66504 , 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)