Provider Demographics
NPI:1578710208
Name:GAVIN, REID BONNER (AUD)
Entity Type:Individual
Prefix:DR
First Name:REID
Middle Name:BONNER
Last Name:GAVIN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE B724F
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-5735
Mailing Address - Country:US
Mailing Address - Phone:615-343-4095
Mailing Address - Fax:615-936-3522
Practice Address - Street 1:1301 MEDICAL CENTER DR
Practice Address - Street 2:SUITE B724F
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-5735
Practice Address - Country:US
Practice Address - Phone:615-343-4095
Practice Address - Fax:615-936-3522
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA0000001566231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist