Provider Demographics
NPI:1134162134
Name:D'AMICO, STEPHEN J (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:D'AMICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6688 NOLENSVILLE RD
Mailing Address - Street 2:SUITE 108-159
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8833
Mailing Address - Country:US
Mailing Address - Phone:615-771-9958
Mailing Address - Fax:855-229-1374
Practice Address - Street 1:4200 MURFREESBORO PIKE
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2789
Practice Address - Country:US
Practice Address - Phone:615-771-9958
Practice Address - Fax:855-229-1374
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2016-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD018500207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3704341Medicaid
TN3704341Medicaid
TNA99979Medicare UPIN