Provider Demographics
NPI:1205072303
Name:CREATIVE HEALTHCARE, PLLC
Entity type:Organization
Organization Name:CREATIVE HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:RAINES
Authorized Official - Last Name:LESSLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-309-9982
Mailing Address - Street 1:1836 CROMWELL DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-5616
Mailing Address - Country:US
Mailing Address - Phone:615-309-9982
Mailing Address - Fax:
Practice Address - Street 1:1836 CROMWELL DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-5616
Practice Address - Country:US
Practice Address - Phone:615-309-9982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-21
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35619207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty