Provider Demographics
NPI:1376634907
Name:OLD HICKORY PSYCHIATRIC ASSN PLLC
Entity Type:Organization
Organization Name:OLD HICKORY PSYCHIATRIC ASSN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-206-9111
Mailing Address - Street 1:695 NASHVILLE PIKE 313
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066
Mailing Address - Country:US
Mailing Address - Phone:615-206-9111
Mailing Address - Fax:615-206-9212
Practice Address - Street 1:706 CADET CT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2649
Practice Address - Country:US
Practice Address - Phone:615-206-9111
Practice Address - Fax:615-789-8315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN352612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3879766Medicaid
TN3731127Medicare ID - Type Unspecified
TN3879766Medicaid