Provider Demographics
NPI:1386639219
Name:CARLSON, MICHAEL G (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:G
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:330 23RD AVE N
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1534
Mailing Address - Country:US
Mailing Address - Phone:615-342-5900
Mailing Address - Fax:615-342-7864
Practice Address - Street 1:330 23RD AVE N
Practice Address - Street 2:SUITE 500
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1534
Practice Address - Country:US
Practice Address - Phone:615-342-5900
Practice Address - Fax:615-342-7864
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2015-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD019713207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64915648Medicaid
TN110212235OtherRR MEDICARE
TN3060045Medicaid
TN110212235OtherRR MEDICARE
KY64915648Medicaid