Provider Demographics
NPI:1528126125
Name:B STEPHENS DUDLEY MD PC
Entity type:Organization
Organization Name:B STEPHENS DUDLEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:P
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-222-5200
Mailing Address - Street 1:4230 HARDING PIKE
Mailing Address - Street 2:SUITE 201 WEST
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2013
Mailing Address - Country:US
Mailing Address - Phone:615-222-5200
Mailing Address - Fax:615-222-5267
Practice Address - Street 1:4230 HARDING PIKE
Practice Address - Street 2:SUITE 201 WEST
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-222-5200
Practice Address - Fax:615-222-5267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN011965174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA98327Medicare UPIN
TN3717275Medicare ID - Type Unspecified