Provider Demographics
NPI:1154512069
Name:HARDIE V. SORRELS III MD P
Entity type:Organization
Organization Name:HARDIE V. SORRELS III MD P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DISMUKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-444-2320
Mailing Address - Street 1:715 CASTLE HEIGHTS CT # B
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2666
Mailing Address - Country:US
Mailing Address - Phone:615-444-2320
Mailing Address - Fax:615-449-3163
Practice Address - Street 1:715 CASTLE HEIGHTS CT # B
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2666
Practice Address - Country:US
Practice Address - Phone:615-444-2320
Practice Address - Fax:615-449-3163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3371592Medicare PIN