Provider Demographics
NPI:1114148277
Name:REPRODUCTIVE SPECIALTY LABORATORY OF TENNESSEE, LLC
Entity Type:Organization
Organization Name:REPRODUCTIVE SPECIALTY LABORATORY OF TENNESSEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:815-321-4740
Mailing Address - Street 1:345 23RD AVE N
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1513
Mailing Address - Country:US
Mailing Address - Phone:615-321-4740
Mailing Address - Fax:615-320-0240
Practice Address - Street 1:345 23RD AVE N
Practice Address - Street 2:SUITE 401
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1513
Practice Address - Country:US
Practice Address - Phone:615-321-4740
Practice Address - Fax:615-320-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3287291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory