Provider Demographics
NPI:1700198793
Name:MIDDLE TENNESSEE VASCULAR ASSOCIATES, PLC
Entity Type:Organization
Organization Name:MIDDLE TENNESSEE VASCULAR ASSOCIATES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PULLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-791-4790
Mailing Address - Street 1:808 HATCHER LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3524
Mailing Address - Country:US
Mailing Address - Phone:931-388-6256
Mailing Address - Fax:931-540-8732
Practice Address - Street 1:808 HATCHER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3524
Practice Address - Country:US
Practice Address - Phone:931-388-6256
Practice Address - Fax:931-540-8732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN154442086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty