Provider Demographics
NPI:1639253495
Name:DOWINS PEDIATRIC CLINIC
Entity Type:Organization
Organization Name:DOWINS PEDIATRIC CLINIC
Other - Org Name:DEIDRE LANIER MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEIDRE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-327-3801
Mailing Address - Street 1:404 D B TODD BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:615-327-3801
Mailing Address - Fax:615-329-0694
Practice Address - Street 1:404 D B TODD BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-327-3801
Practice Address - Fax:615-329-0694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD16121208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN13044168Medicaid
TN13044168Medicaid