Provider Demographics
NPI:1679742423
Name:AFFILIATED DERMATOLOGISTS OF GREEN HILLS PC
Entity Type:Organization
Organization Name:AFFILIATED DERMATOLOGISTS OF GREEN HILLS PC
Other - Org Name:RETIEF SKIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RETIEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-383-6092
Mailing Address - Street 1:PO BOX 440336
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-3345
Mailing Address - Country:US
Mailing Address - Phone:615-383-6092
Mailing Address - Fax:615-292-8424
Practice Address - Street 1:4301 HILLSBORO PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3345
Practice Address - Country:US
Practice Address - Phone:615-383-6092
Practice Address - Fax:615-292-8424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD34844207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty