Provider Demographics
NPI:1467687822
Name:CENTENNIAL PSYCHIATRIC ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CENTENNIAL PSYCHIATRIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-5135
Mailing Address - Street 1:310 25TH AVE N
Mailing Address - Street 2:SUITE 307
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1515
Mailing Address - Country:US
Mailing Address - Phone:615-320-8887
Mailing Address - Fax:615-320-8878
Practice Address - Street 1:310 25TH AVE N
Practice Address - Street 2:SUITE 307
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1515
Practice Address - Country:US
Practice Address - Phone:615-320-8887
Practice Address - Fax:615-320-8878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514874Medicaid
TN3373616Medicare PIN
DP0607Medicare PIN