Provider Demographics
NPI:1619314226
Name:HARTSFIELD, MILES (DO)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:
Last Name:HARTSFIELD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E SWAN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37033-1417
Mailing Address - Country:US
Mailing Address - Phone:931-729-1961
Mailing Address - Fax:
Practice Address - Street 1:501 GREAT CIRCLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1317
Practice Address - Country:US
Practice Address - Phone:615-222-7576
Practice Address - Fax:615-222-7237
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2803207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ023169Medicaid
TN10308I0893Medicare PIN