Provider Demographics
NPI:1578588414
Name:NASHVILLE MED PEDS LLC
Entity Type:Organization
Organization Name:NASHVILLE MED PEDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:O
Authorized Official - Last Name:BAGGOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-865-4996
Mailing Address - Street 1:3443 DICKERSON PIKE
Mailing Address - Street 2:SUITE 460
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2519
Mailing Address - Country:US
Mailing Address - Phone:615-865-4996
Mailing Address - Fax:615-868-7857
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:SUITE 460
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2519
Practice Address - Country:US
Practice Address - Phone:615-865-4996
Practice Address - Fax:615-868-7857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38796207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3727139Medicaid
TN3727139Medicare PIN
TNDE6180Medicare PIN