Provider Demographics
NPI:1033467188
Name:TENNESSEE MATERNAL FETAL MEDICINE PLC
Entity Type:Organization
Organization Name:TENNESSEE MATERNAL FETAL MEDICINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-983-5404
Mailing Address - Street 1:300 20TH AVE N
Mailing Address - Street 2:SUITE 702
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2131
Mailing Address - Country:US
Mailing Address - Phone:615-284-8636
Mailing Address - Fax:615-284-8637
Practice Address - Street 1:404 N CASTLE HEIGHTS AVE
Practice Address - Street 2:SUITE E
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1511
Practice Address - Country:US
Practice Address - Phone:615-983-5404
Practice Address - Fax:615-284-8637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty