Provider Demographics
NPI:1235862293
Name:GAD, EBRAHIEM A
Entity Type:Individual
Prefix:
First Name:EBRAHIEM
Middle Name:A
Last Name:GAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 WAVELAND CT
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-5286
Mailing Address - Country:US
Mailing Address - Phone:201-844-3670
Mailing Address - Fax:
Practice Address - Street 1:1818 ALBION ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-2918
Practice Address - Country:US
Practice Address - Phone:615-341-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000229155163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse