Provider Demographics
NPI:1477929917
Name:DILLER, AMY WHITE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:WHITE
Last Name:DILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:301 S PERIMETER PARK DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4143
Mailing Address - Country:US
Mailing Address - Phone:615-295-2176
Mailing Address - Fax:615-295-2645
Practice Address - Street 1:1630 S CHURCH ST
Practice Address - Street 2:STE 104
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-5551
Practice Address - Country:US
Practice Address - Phone:615-295-2176
Practice Address - Fax:615-295-2645
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1534575Medicaid