Provider Demographics
NPI:1225682198
Name:TENNESSEE CENTER FOR BRAIN HEALTH
Entity Type:Organization
Organization Name:TENNESSEE CENTER FOR BRAIN HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SRAVANI
Authorized Official - Middle Name:VENKATA ANJANA
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-482-5535
Mailing Address - Street 1:9005 FALLSWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8679
Mailing Address - Country:US
Mailing Address - Phone:615-482-5535
Mailing Address - Fax:
Practice Address - Street 1:2900 FELICIA ST STE 103
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-4043
Practice Address - Country:US
Practice Address - Phone:615-450-6758
Practice Address - Fax:908-282-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ050091Medicaid