Provider Demographics
NPI:1790757755
Name:LETT, EARL DWAYNE (MD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:DWAYNE
Last Name:LETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:410 42ND AVE N STE 400
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3658
Mailing Address - Country:US
Mailing Address - Phone:615-329-7887
Mailing Address - Fax:615-346-6225
Practice Address - Street 1:660 S MOUNT JULIET RD STE 210
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3973
Practice Address - Country:US
Practice Address - Phone:615-443-0901
Practice Address - Fax:615-442-0310
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2023-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD25738174400000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE74340Medicare UPIN