Provider Demographics
NPI:1184887580
Name:MOREHOUSE NGUYEN, AMANDA JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JEAN
Last Name:MOREHOUSE NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:JEAN
Other - Last Name:MOREHOUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5653 FRIST BLVD STE 239
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2063
Mailing Address - Country:US
Mailing Address - Phone:615-232-9070
Mailing Address - Fax:
Practice Address - Street 1:5653 FRIST BLVD STE 239
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2063
Practice Address - Country:US
Practice Address - Phone:615-232-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64682208600000X
TN57094208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
202I020951Medicare PIN