Provider Demographics
NPI:1942314075
Name:SORRELS, HARDIE V III (MD)
Entity Type:Individual
Prefix:
First Name:HARDIE
Middle Name:V
Last Name:SORRELS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1870
Mailing Address - Country:US
Mailing Address - Phone:629-255-3486
Mailing Address - Fax:
Practice Address - Street 1:715B CASTLE HEIGHTS CT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2646
Practice Address - Country:US
Practice Address - Phone:629-255-2274
Practice Address - Fax:629-255-4250
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3033052Medicaid
TN3033052Medicaid
TN3033052Medicare PIN