Provider Demographics
NPI:1699496455
Name:NASHVILLE UROLOGY PC
Entity type:Organization
Organization Name:NASHVILLE UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERELY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRADDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-270-8060
Mailing Address - Street 1:2201 MURPHY AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1926
Mailing Address - Country:US
Mailing Address - Phone:615-270-8060
Mailing Address - Fax:
Practice Address - Street 1:2201 MURPHY AVE STE 203
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1926
Practice Address - Country:US
Practice Address - Phone:615-270-8060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ019467Medicaid