Provider Demographics
NPI:1942332499
Name:FRIDDELL, COLLEEN S (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:S
Last Name:FRIDDELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 ELM HILL PIKE
Mailing Address - Street 2:SUITE M
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3155
Mailing Address - Country:US
Mailing Address - Phone:615-232-8696
Mailing Address - Fax:615-232-8234
Practice Address - Street 1:2601 ELM HILL PIKE
Practice Address - Street 2:SUITE M
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3155
Practice Address - Country:US
Practice Address - Phone:615-232-8696
Practice Address - Fax:615-232-8234
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000307292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG87064Medicare UPIN
TN3837267Medicare ID - Type Unspecified