Provider Demographics
NPI:1609178102
Name:STONES RIVER DERMATOLOGY PLC
Entity Type:Organization
Organization Name:STONES RIVER DERMATOLOGY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-904-2010
Mailing Address - Street 1:515 HIGHLAND TER STE A
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2423
Mailing Address - Country:US
Mailing Address - Phone:615-904-2010
Mailing Address - Fax:615-904-6285
Practice Address - Street 1:515 HIGHLAND TER STE A
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2423
Practice Address - Country:US
Practice Address - Phone:615-904-2010
Practice Address - Fax:615-904-6285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD31447207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3871904Medicare PIN