Basic Information
| Provider Information | |||||||||
| NPI: | 1659849537 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANOVA MEDICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1156 NASHVILLE PIKE | ||||||||
| Address2: | |||||||||
| City: | GALLATIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159894311 | ||||||||
| FaxNumber: | 6159894661 | ||||||||
| Practice Location | |||||||||
| Address1: | 1156 NASHVILLE PIKE | ||||||||
| Address2: | |||||||||
| City: | GALLATIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159894311 | ||||||||
| FaxNumber: | 6159894661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2018 | ||||||||
| LastUpdateDate: | 10/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | KING | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICAL | ||||||||
| AuthorizedOfficialTelephone: | 6158186914 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.