Provider Demographics
NPI:1093560187
Name:PAVLOVIC, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:PAVLOVIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 GWYNN DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37216-1716
Mailing Address - Country:US
Mailing Address - Phone:360-624-7025
Mailing Address - Fax:
Practice Address - Street 1:3441 LEBANON PIKE STE 108
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2000
Practice Address - Country:US
Practice Address - Phone:615-544-6391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)