Provider Demographics
NPI:1255463717
Name:STEWART-RAMAGE, PHYLEEN
Entity type:Individual
Prefix:
First Name:PHYLEEN
Middle Name:
Last Name:STEWART-RAMAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PHYLEEN
Other - Middle Name:STEWART
Other - Last Name:RAMAGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5300 MARYLAND WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5074
Mailing Address - Country:US
Mailing Address - Phone:615-507-2082
Mailing Address - Fax:
Practice Address - Street 1:5300 MARYLAND WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5074
Practice Address - Country:US
Practice Address - Phone:615-507-2082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0238712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
106011OtherVALUE OPTIONS
3034267OtherBCBS
106011OtherVALUE OPTIONS