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6606 Charlotte Pike Ste# 104 Nashville TN 37209-4202 | |
| (615) 630-6095 | |
| (615) 630-6099 |
| Full Name | |
|---|---|
| Speciality | General Practice |
| Location | 6606 Charlotte Pike, Nashville, Tennessee |
| Authorized Official Name and Position | Randy Johansen (PRESIDENT) |
| Authorized Official Contact | 2054212102 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2147 Riverchase Office Rd Birmingham AL 35244-1836 Ph: (205) 403-8902 | 6606 Charlotte Pike Ste# 104 Nashville TN 37209-4202 Ph: (615) 630-6095 |
| NPI Number | 1043526528 |
|---|---|
| Provider Enumeration Date | 08/23/2010 |
| Last Update Date | 08/23/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043526528 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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