Provider Demographics
NPI:1588655021
Name:ANDERSON, EDWIN B JR (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:B
Last Name:ANDERSON
Suffix:JR
Gender:M
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:37203-1852
Mailing Address - Country:US
Mailing Address - Phone:629-255-3486
Mailing Address - Fax:
Practice Address - Street 1:4230 HARDING PIKE STE 501
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2018
Practice Address - Country:US
Practice Address - Phone:629-255-2131
Practice Address - Fax:629-255-4097
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD08886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3179671Medicaid
TND32126Medicare UPIN
TN3179671Medicare PIN