Provider Demographics
NPI:1336521301
Name:MIDDLE TENNESSEE PSYCHIATRIC CLINIC
Entity Type:Organization
Organization Name:MIDDLE TENNESSEE PSYCHIATRIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-383-4694
Mailing Address - Street 1:2011 ASHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-5015
Mailing Address - Country:US
Mailing Address - Phone:615-383-4694
Mailing Address - Fax:615-383-0228
Practice Address - Street 1:2011 ASHWOOD AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-5015
Practice Address - Country:US
Practice Address - Phone:615-383-4694
Practice Address - Fax:615-383-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty