Provider Demographics
NPI:1215094982
Name:MATHIS, MESHA LAYMAN (PA-C)
Entity type:Individual
Prefix:
First Name:MESHA
Middle Name:LAYMAN
Last Name:MATHIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MESHA
Other - Middle Name:MICHELLE
Other - Last Name:LAYMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2410 PATTERSON ST BSMT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1551
Mailing Address - Country:US
Mailing Address - Phone:615-342-4850
Mailing Address - Fax:
Practice Address - Street 1:2410 PATTERSON ST BSMT
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1551
Practice Address - Country:US
Practice Address - Phone:615-342-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002486363A00000X
TN4116363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100000921AMedicaid
GA97BBBRDMedicare ID - Type Unspecified