Provider Demographics
NPI:1821233529
Name:GREATER NASHVILLE PERINATOLOGY PLC
Entity Type:Organization
Organization Name:GREATER NASHVILLE PERINATOLOGY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-984-7682
Mailing Address - Street 1:300 STONECREST BLVD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5688
Mailing Address - Country:US
Mailing Address - Phone:615-459-2051
Mailing Address - Fax:615-459-2061
Practice Address - Street 1:300 STONECREST BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5688
Practice Address - Country:US
Practice Address - Phone:615-459-2051
Practice Address - Fax:615-459-2061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37775207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty