Basic Information
| Provider Information | |||||||||
| NPI: | 1255738043 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONWAY THERAPEUTICS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 WALLACE RD | ||||||||
| Address2: | SUITE103 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372114893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158325530 | ||||||||
| FaxNumber: | 6158325713 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 WALLACE RD | ||||||||
| Address2: | SUITE103 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372114893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158325530 | ||||||||
| FaxNumber: | 6158325713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2014 | ||||||||
| LastUpdateDate: | 11/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | HERRING | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6158325530 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | MD0000016892 | TN | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.