Provider Demographics
NPI:1518203777
Name:DIAGNOVUS, LLC
Entity Type:Organization
Organization Name:DIAGNOVUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:615-351-1139
Mailing Address - Street 1:336 HILL AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-4712
Mailing Address - Country:US
Mailing Address - Phone:855-642-8438
Mailing Address - Fax:
Practice Address - Street 1:336 HILL AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-4712
Practice Address - Country:US
Practice Address - Phone:855-642-8438
Practice Address - Fax:855-893-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44D2062333291U00000X
AZ03D1063366291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory