Provider Demographics
NPI:1780881474
Name:REA, BAYARD DODGE (PSYD)
Entity type:Individual
Prefix:DR
First Name:BAYARD
Middle Name:DODGE
Last Name:REA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:B. DODGE
Other - Middle Name:
Other - Last Name:REA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:2919 BERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3126
Mailing Address - Country:US
Mailing Address - Phone:615-577-0995
Mailing Address - Fax:614-577-0997
Practice Address - Street 1:2919 BERRY HILL DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3126
Practice Address - Country:US
Practice Address - Phone:615-577-0995
Practice Address - Fax:614-577-0997
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002482103TC0700X, 103TF0000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy