Provider Demographics
NPI:1760075980
Name:AZATH, NATNAEL TAMERE
Entity Type:Individual
Prefix:
First Name:NATNAEL
Middle Name:TAMERE
Last Name:AZATH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 LINBAR DR APT C101
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5043
Mailing Address - Country:US
Mailing Address - Phone:615-578-6199
Mailing Address - Fax:
Practice Address - Street 1:5101 LINBAR DR APT C101
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5043
Practice Address - Country:US
Practice Address - Phone:615-578-6199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
TN135125512347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)