Provider Demographics
NPI:1114916095
Name:AUGUST, LEILA M (MD)
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:M
Last Name:AUGUST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 440100
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0100
Mailing Address - Country:US
Mailing Address - Phone:615-329-0570
Mailing Address - Fax:615-320-7091
Practice Address - Street 1:225 BIG STATION CAMP BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-8464
Practice Address - Country:US
Practice Address - Phone:615-451-5481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36329207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H72257Medicare UPIN