Provider Demographics
NPI:1750362711
Name:KONDIS, DEBORAH J (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:KONDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 CHURCH ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2000
Mailing Address - Country:US
Mailing Address - Phone:615-284-6555
Mailing Address - Fax:615-284-6558
Practice Address - Street 1:2011 CHURCH ST
Practice Address - Street 2:SUITE 403
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2000
Practice Address - Country:US
Practice Address - Phone:615-284-6555
Practice Address - Fax:615-284-6558
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17301207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN160026801Medicaid
TN3009669OtherBCBS
TN160026801Medicaid
TN3024991Medicare ID - Type Unspecified