Provider Demographics
NPI:1386933166
Name:TENNESSEE PEDIATRIC & ADOLESCENT CENTER
Entity type:Organization
Organization Name:TENNESSEE PEDIATRIC & ADOLESCENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SATYA
Authorized Official - Middle Name:NARAYAN
Authorized Official - Last Name:CHAKRABARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-526-6100
Mailing Address - Street 1:435 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-5401
Mailing Address - Country:US
Mailing Address - Phone:931-526-6100
Mailing Address - Fax:931-526-6002
Practice Address - Street 1:435 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-5401
Practice Address - Country:US
Practice Address - Phone:931-526-6100
Practice Address - Fax:931-526-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD28171173000000X
TNMD44069173000000X
TNRN0000148368363L00000X
TNAPN15014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty