Provider Demographics
NPI:1417009440
Name:RHODES, MICHAEL A SR (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:RHODES
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:105. B. MEMORIAL DR.
Mailing Address - Street 2:SUITE B
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072
Mailing Address - Country:US
Mailing Address - Phone:615-239-8359
Mailing Address - Fax:615-448-6137
Practice Address - Street 1:105. B. MEMORIAL DR.
Practice Address - Street 2:SUITE B
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072
Practice Address - Country:US
Practice Address - Phone:615-239-8359
Practice Address - Fax:615-448-6137
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000037647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH94142Medicare UPIN