Provider Demographics
NPI:1114010386
Name:ASSOCIATED PODIATRISTS OF TENNESSEE
Entity Type:Organization
Organization Name:ASSOCIATED PODIATRISTS OF TENNESSEE
Other - Org Name:DICKSON FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMGSH
Authorized Official - Middle Name:BABU
Authorized Official - Last Name:PAVULURI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:615-441-0002
Mailing Address - Street 1:214 SKYLINE CIR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2561
Mailing Address - Country:US
Mailing Address - Phone:615-441-0002
Mailing Address - Fax:615-446-2827
Practice Address - Street 1:214 SKYLINE CIR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2561
Practice Address - Country:US
Practice Address - Phone:615-441-0002
Practice Address - Fax:615-446-2827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3352104Medicare ID - Type Unspecified