Basic Information
| Provider Information | |||||||||
| NPI: | 1669465654 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HERMITAGE PSYCHIATRIC GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5653 FRIST BLVD | ||||||||
| Address2: | SUITE 331 | ||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370762062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158894447 | ||||||||
| FaxNumber: | 6158895891 | ||||||||
| Practice Location | |||||||||
| Address1: | 5653 FRIST BLVD | ||||||||
| Address2: | SUITE 331 | ||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370762062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158894447 | ||||||||
| FaxNumber: | 6158895891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | CHALKO | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDER | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6158894447 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.