Provider Demographics
NPI:1912929787
Name:ABBOTT, TIMOTHY CLAY (DPM)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CLAY
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:TIMOTHY
Other - Middle Name:CLAY
Other - Last Name:ABBOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:411 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211
Mailing Address - Country:US
Mailing Address - Phone:615-331-1240
Mailing Address - Fax:615-331-0695
Practice Address - Street 1:411 HIGH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211
Practice Address - Country:US
Practice Address - Phone:615-331-1240
Practice Address - Fax:615-331-0695
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN294213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist