Provider Demographics
NPI:1902406549
Name:HERMITAGE DIRECT PRIMARY CARE
Entity Type:Organization
Organization Name:HERMITAGE DIRECT PRIMARY CARE
Other - Org Name:HERMITAGE DIRECT PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAIER-MULLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-206-8668
Mailing Address - Street 1:1443 LONG HOLLOW PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-8589
Mailing Address - Country:US
Mailing Address - Phone:615-922-8029
Mailing Address - Fax:
Practice Address - Street 1:357 RIVERSIDE DR STE 260
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-8974
Practice Address - Country:US
Practice Address - Phone:615-206-8668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty