Provider Demographics
NPI:1013109511
Name:MID SOUTH PSYCHIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:MID SOUTH PSYCHIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:I
Authorized Official - Last Name:FAROOQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-895-8104
Mailing Address - Street 1:1830 HERITAGE PARK PLZ
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-1575
Mailing Address - Country:US
Mailing Address - Phone:615-895-8104
Mailing Address - Fax:615-895-7903
Practice Address - Street 1:1830 HERITAGE PARK PLZ
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1575
Practice Address - Country:US
Practice Address - Phone:615-895-8104
Practice Address - Fax:615-895-7903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000020287103TP0016X
TNMD0000018343103TP0016X
TN41961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861608895OtherNPI
TN3706880Medicaid
1558479170OtherNPI
1922116649OtherNPI
1922116649OtherNPI
3924727Medicare PIN
3064118Medicare PIN
E74183Medicare UPIN
F02951Medicare UPIN