Provider Demographics
NPI:1497828321
Name:TENNESSEE RETINA PC
Entity Type:Organization
Organization Name:TENNESSEE RETINA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:C
Authorized Official - Last Name:AWH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-983-6000
Mailing Address - Street 1:345 23RD AVE N
Mailing Address - Street 2:SUITE 350
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1513
Mailing Address - Country:US
Mailing Address - Phone:615-983-6000
Mailing Address - Fax:615-983-6010
Practice Address - Street 1:345 23RD AVE N
Practice Address - Street 2:SUITE 350
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1513
Practice Address - Country:US
Practice Address - Phone:615-983-6000
Practice Address - Fax:615-983-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3379053Medicare ID - Type Unspecified