| Waukegan Clinic Corporation | |
|
3443 Dickerson Pike Ste 580 Nashville TN 37207-2526 | |
| (615) 860-1351 | |
| (615) 860-1242 |
| Full Name | Waukegan Clinic Corporation |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3443 Dickerson Pike Ste 580, Nashville, Tennessee |
| Authorized Official Name and Position | Louis R Joseph (VICE PRESIDENT) |
| Authorized Official Contact | 6153737630 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Waukegan Clinic Corporation 2000 Health Park Dr Brentwood TN 37027-4525 Ph: (615) 860-1351 | Waukegan Clinic Corporation 3443 Dickerson Pike Ste 580 Nashville TN 37207-2526 Ph: (615) 860-1351 |
| NPI Number | 1033154786 |
|---|---|
| Provider Enumeration Date | 06/17/2006 |
| Last Update Date | 07/19/2019 |
| Medicare PECOS PAC ID | 6800845702 |
|---|---|
| Medicare Enrollment ID | O20050118000866 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033154786 | NPI | - | NPPES |
| 1306937289 | Medicaid | IL | |
| 036143179 | Medicaid | IL | |
| 204872623 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 036143179 (Illinois) | Primary |
| Provider Name | Evana C Yates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235308305 PECOS PAC ID: 2466342183 Enrollment ID: I20040317000633 |
| Provider Name | Sonya Fidelia Brooks |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1144214701 PECOS PAC ID: 3577512490 Enrollment ID: I20050118000993 |
| Provider Name | Mary E Clinton |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1760484760 PECOS PAC ID: 9234155888 Enrollment ID: I20051021000872 |
| Provider Name | Latai Ebrette Grant Brown |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1679519573 PECOS PAC ID: 9032128657 Enrollment ID: I20060410000621 |
| Provider Name | John C Witt |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1972591923 PECOS PAC ID: 0244393692 Enrollment ID: I20090110000117 |
| Provider Name | Michael J Kaminski |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1134121130 PECOS PAC ID: 6002714086 Enrollment ID: I20090212000248 |
| Provider Name | Bashar A Mohsen |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1114953650 PECOS PAC ID: 0648275917 Enrollment ID: I20110510000132 |
| Provider Name | Paulo Acosta |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1710097761 PECOS PAC ID: 2769394048 Enrollment ID: I20110921000456 |
| Provider Name | Stephen L Mcdonald |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1093159444 PECOS PAC ID: 3779857735 Enrollment ID: I20170914003281 |
| Provider Name | Amanda Adelle Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972196699 PECOS PAC ID: 1456760685 Enrollment ID: I20210429001052 |
| Provider Name | Dennis Franklin Cole |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1720434277 PECOS PAC ID: 5890081426 Enrollment ID: I20210713001705 |
| Provider Name | Salah Uddin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1346332004 PECOS PAC ID: 5799755401 Enrollment ID: I20211101001191 |
| Provider Name | Kelsey Peters |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1306376652 PECOS PAC ID: 9133498306 Enrollment ID: I20220915003785 |
| Provider Name | Lavanya Nagineni |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1699986943 PECOS PAC ID: 1254495690 Enrollment ID: I20231003000967 |
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