Provider Demographics
NPI:1932915253
Name:GARDNER, MICHAEL ANDREW
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANDREW
Last Name:GARDNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 SEWANEE RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37220-1017
Mailing Address - Country:US
Mailing Address - Phone:615-943-7782
Mailing Address - Fax:
Practice Address - Street 1:1921 RANSOM PL
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-3841
Practice Address - Country:US
Practice Address - Phone:615-279-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty