Provider Demographics
NPI:1669465654
Name:HERMITAGE PSYCHIATRIC GROUP
Entity Type:Organization
Organization Name:HERMITAGE PSYCHIATRIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHALKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-889-4447
Mailing Address - Street 1:5653 FRIST BLVD
Mailing Address - Street 2:SUITE 331
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2062
Mailing Address - Country:US
Mailing Address - Phone:615-889-4447
Mailing Address - Fax:615-889-5891
Practice Address - Street 1:5653 FRIST BLVD
Practice Address - Street 2:SUITE 331
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2062
Practice Address - Country:US
Practice Address - Phone:615-889-4447
Practice Address - Fax:615-889-5891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherAETNA
TN=========OtherCIGNA
TN=========OtherMAGELLAN
TN=========OtherUNITED BEHAVIORAL HEALTH
TN=========Medicaid
TN=========OtherBLUE CROSS BLUE SHIELD
TN=========OtherCOMPSYCH
TN=========OtherTRICARE/CHAMPUS
TN=========OtherVALUE OPTIONS
TN=========OtherUNITED HEALTHCARE
TN=========Medicaid