1770961617 NPI number — BENJAMIN GARMEZY MD

Table of content: BENJAMIN GARMEZY MD (NPI 1770961617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770961617 NPI number — BENJAMIN GARMEZY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARMEZY
Provider First Name:
BENJAMIN
Provider Middle Name:
Provider Name Prefix Text:
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:
1770961617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2004 HAYES ST
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-329-0570
Provider Business Mailing Address Fax Number:
615-329-0579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 25TH AVE. N
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-986-4366
Provider Business Practice Location Address Fax Number:
615-320-1617
Provider Enumeration Date:
05/12/2015

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: 207R00000X , with the licence number:  R7740 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , with the licence number: 4301106990 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 63357 , 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: 8LB694 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 398423902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 398423901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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