Basic Information
| Provider Information | |||||||||
| NPI: | 1235647058 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDDLE TENNESSEE ANESTHESIA PROVIDERS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 293357 | ||||||||
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| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372293357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6156202320 | ||||||||
| FaxNumber: | 6156202323 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 PHYSICIANS WAY | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370904135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6155219097 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2018 | ||||||||
| LastUpdateDate: | 01/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | WILLIS | ||||||||
| AuthorizedOfficialFirstName: | DANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6156202320 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.