Provider Demographics
NPI:1740222538
Name:FOTTRELL, ANNE AUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:AUSTIN
Last Name:FOTTRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 18TH AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2253
Mailing Address - Country:US
Mailing Address - Phone:615-292-3661
Mailing Address - Fax:615-292-3662
Practice Address - Street 1:317 18TH AVE N STE 200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2253
Practice Address - Country:US
Practice Address - Phone:615-292-3661
Practice Address - Fax:615-292-3662
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00199612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441015Medicaid
TN5441015Medicaid
TN3078947Medicare ID - Type Unspecified