Provider Demographics
NPI:1336391325
Name:CROSSROADS PEDIATRIC GROUP, PLLC
Entity Type:Organization
Organization Name:CROSSROADS PEDIATRIC GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-672-7122
Mailing Address - Street 1:491 SAGE RD N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-9138
Mailing Address - Country:US
Mailing Address - Phone:615-672-7122
Mailing Address - Fax:615-672-7849
Practice Address - Street 1:491 SAGE RD N
Practice Address - Street 2:SUITE 200
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-9138
Practice Address - Country:US
Practice Address - Phone:615-672-7122
Practice Address - Fax:615-672-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43871174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty