Provider Demographics
NPI:1346568953
Name:CASILLI, TABITHA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:ANNE
Last Name:CASILLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:ANNE
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:222 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1870
Mailing Address - Country:US
Mailing Address - Phone:629-255-3486
Mailing Address - Fax:629-255-3075
Practice Address - Street 1:920 S HARTMANN DR STE 200
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-4137
Practice Address - Country:US
Practice Address - Phone:629-255-2024
Practice Address - Fax:629-255-4215
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49581208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1531699Medicaid