Provider Demographics
NPI:1982767646
Name:NASHVILLE PERIODONTAL GROUP, PA
Entity type:Organization
Organization Name:NASHVILLE PERIODONTAL GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:AKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-385-3334
Mailing Address - Street 1:2000 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4314
Mailing Address - Country:US
Mailing Address - Phone:615-385-3334
Mailing Address - Fax:615-385-3335
Practice Address - Street 1:2000 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4314
Practice Address - Country:US
Practice Address - Phone:615-385-3334
Practice Address - Fax:615-385-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN69061223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty