Basic Information
| Provider Information | |||||||||
| NPI: | 1851564827 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROACH | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 COOL SPRINGS BLVD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370676448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6155504030 | ||||||||
| FaxNumber: | 6155504040 | ||||||||
| Practice Location | |||||||||
| Address1: | 5505 EDMONDSON PIKE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372115872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153315898 | ||||||||
| FaxNumber: | 6153315705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2008 | ||||||||
| LastUpdateDate: | 06/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 47080 | TN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.