Provider Demographics
NPI:1891190955
Name:TENNESSEE OBSTETRICS & GYNECOLOGY PLLC
Entity Type:Organization
Organization Name:TENNESSEE OBSTETRICS & GYNECOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-373-1255
Mailing Address - Street 1:343 FRANKLIN RD
Mailing Address - Street 2:STE 108
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5250
Mailing Address - Country:US
Mailing Address - Phone:615-373-1255
Mailing Address - Fax:615-371-9040
Practice Address - Street 1:343 FRANKLIN RD
Practice Address - Street 2:STE 108
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5250
Practice Address - Country:US
Practice Address - Phone:615-373-1255
Practice Address - Fax:615-371-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN011790174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3186006OtherMEDICARE PTAN