Provider Demographics
NPI:1124082797
Name:LETT, DONNA WOODALL (MD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:WOODALL
Last Name:LETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1870
Mailing Address - Country:US
Mailing Address - Phone:629-255-3486
Mailing Address - Fax:629-255-3075
Practice Address - Street 1:920 S HARTMANN DR STE 200
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-4137
Practice Address - Country:US
Practice Address - Phone:629-255-2031
Practice Address - Fax:629-255-4222
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD25130208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3094882Medicaid
TNE74632Medicare UPIN
TN3094882Medicaid